Pioneer Days Day Camp Registration Form

Open to all girls entering 1st through 12th grade.

Fee includes: snacks Monday, Tuesday and Wednesday; dinner Thursday night; breakfast Friday morning; official camp patch; and all program activities.

Registered Girl Scouts	If Not Registered as a Girl Scout
$75 for girls	$90 for girls
$10 for adult helpers	$25 for adult helpers
	$10 for tots

Note: All girls and adults must wear a Girl Scout t-shirt or other Girl Scout camp shirt.

A camp information packet will be mailed to you in late July.

1	Child's Name:
		(first)	(last)
	Child is currently registered with troop # Child is not a registered Girl Scout. I will submit an girl registration form with this form. Click here to download the Girl Registration form   Click here to download the Girl Financial Aid form
	Grade in fall:
	Shirt size: Child Sm   Child Med   Child Lg   Adult Sm   Adult Med   Adult Lg   XL
	Medical concerns:

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2	Child's Name:
		(first)	(last)
	Child is currently registered with troop # Child is not a registered Girl Scout. I will submit an girl registration form with this form. Click here to download the Girl Registration form   Click here to download the Girl Financial Aid form
	Grade in fall:
	Shirt size: Child Sm   Child Med   Child Lg   Adult Sm   Adult Med   Adult Lg   XL
	Medical concerns:

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3	Child's Name:
		(first)	(last)
	Child is currently registered with troop # Child is not a registered Girl Scout. I will submit an girl registration form with this form. Click here to download the Girl Registration form   Click here to download the Girl Financial Aid form
	Grade in fall:
	Shirt size: Child Sm   Child Med   Child Lg   Adult Sm   Adult Med   Adult Lg   XL
	Medical concerns:

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4	Tot Lot:
	A save place for your youngsters while you help.
	I will bring tot(s). I understand the fee for each tot is $10 and includes a t-shirt and special insurance.

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5	Adult Name:
	registering for camp	(first)	(last)
I would like to help at camp. I am available on the following day(s). Please check any or all!
	August 3-5 8:00 am - 3:15 pm August 6-7 1:00 pm Thursday - 10:00 am Friday Monday Tuesday Wednesday Overnight Campout
	All adults working at camp must be registered Girl Scouts.
	I am currently registered with troop # I not am currently registered. I will submit an adult registration form along with the $25 camp fee. Click here to download the Adult Registration form
	Shirt size: Adult Sm   Adult Med   Adult Lg   XL   2X   3X
	Medical concerns:
Sorry, but I can't help this year.

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Children's Physician (name, phone, and insurance information)

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Parent/Guardian:
	(first)	(last)
Address:
City:
State:		Zip:
Home Phone:		Work Phone:
Cell Phone:		Email:
Emergency Contact name and phone: