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2019 Clean Sweep Patch & Certificate Request
Complete this form AFTER your cleanup. GROUP LEADERS -- BEFORE YOU BEGIN: Be sure you have the correct spelling for all individuals, and consider any tag-a-longs or other helpers (siblings, parents, friends) who are not official members of your group and whether the certificate should include the name of the group (example: brothers helping a Girl Scout troop).
Group Name *
As it should appear on the certificates, e.g. "Girl Scout Troop 363." If you are reporting as an individual, enter your own name
Your answer
Contact Name *
Your answer
Contact email
Your answer
Contact phone
Your answer
Where we can send the certificates and/or patches
Your answer
Please check a preference *
Please list the name of each person who should receive a certificate (one person per line).
Groups may have some individuals who prefer not to have the group name on the certificate, like tag-a-longs or parents. Please indicate how these certificates should read.
Your answer
How many patches without certificates would you like?
Example: A Scout troop may want an extra patch for a scrap book, or some participants may want patches without certificates.
Your answer
Any other comments or special instructions?
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