Camp Primavera 2014- Registration is now closed!

1. Camp Primavera 2014

This is a short registration form for your child to attend Camp Primavera from April 14-17 at Camp Crowell in Oakton, VA. Please answer every question.

You will receive a confirmation e-mail that your daughter has been placed after the April 4th deadline. Please do not contact us until after that date. We ask that you only register one time. Entering multiple registrations for your child will slow down the process.

Please note: If your daughter is a Girl Scout, she will be placed on a waiting list. Thank you.

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* 1. Child's Name and Last Name:

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* 2. I am registering a:

Girl

Boy

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* 3. Age:

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* 4. Date of Birth:

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* 5. Address:

Address:

Apartment Number:

City:

State:

ZIP Code:

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* 6. Current School Attending:

Name:

State:

Grade:

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* 7. Parent/Guardian:

Name:

Phone Day:

Phone Evening:

Phone Cell:

e-mail:

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* 8. Parent/Guardian 2:

Name:

Phone Day:

Phone Evening:

Phone Cell:

e-mail:

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* 9. If divorced or legally separated, please indicate the custodial parent(s):

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* 10. Emergency Contact Information (not listed above):

Name/Relationship:

Phone:

Name/Relationship:

Phone:

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* 11. Are you currently a registered Girl Scout?

Yes

If yes, enter troop #: Please note current Girl Scouts will not be placed unless there are slots remaining after the deadline.

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* 12. Do you need Bus Transportation?

Yes

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* 13. Which Bus Stop will your child use?

Bull Run Elementary

Centre Ridge Elementary

Centreville Elementary

London Towne Elementary

Kings Park Elementary

Laurel Ridge Elementary

I will drive her to camp.

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* 14. For security reasons we need an adult at every bus stop making sure the girls safely get on and off the bus. Can you help us with such an important job?

morning only

afternoon only

both morning and afternoon

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* 15. Registrants Racial Background is:
We encourage you to voluntarily provide the following information on racial background and ethnicity. This information will be used by Girl Scouts of the USA to help improve outreach efforts and advance the Girl Scout movement.

American Indian or Alaskan Native

Asian

Black or African American

Hawaiian Pacific Islander

White

Other (please specify)

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* 16. Registrant's Ethnic Background:

Hispanic or Latina

Not Hispanic or Latina

33% of survey complete.

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* 1. Child's Name and Last Name:

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* 2. I am registering a:

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* 3. Age:

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* 4. Date of Birth:

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* 5. Address:

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* 6. Current School Attending:

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* 7. Parent/Guardian:

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* 8. Parent/Guardian 2:

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* 9. If divorced or legally separated, please indicate the custodial parent(s):

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* 10. Emergency Contact Information (not listed above):

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* 11. Are you currently a registered Girl Scout?

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* 12. Do you need Bus Transportation?

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* 13. Which Bus Stop will your child use?

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* 14. For security reasons we need an adult at every bus stop making sure the girls safely get on and off the bus. Can you help us with such an important job?

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* 15. Registrants Racial Background is:We encourage you to voluntarily provide the following information on racial background and ethnicity. This information will be used by Girl Scouts of the USA to help improve outreach efforts and advance the Girl Scout movement.

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* 16. Registrant's Ethnic Background:

* 15. Registrants Racial Background is:
We encourage you to voluntarily provide the following information on racial background and ethnicity. This information will be used by Girl Scouts of the USA to help improve outreach efforts and advance the Girl Scout movement.