Girl Scout Clinic REQUEST FORM
We'd love to have you join us to earn a TeamBuilding Patch with your troop!
Only $10/participant
*Dress in athletic wear, cheer or tennis shoes, hair in high pony. Please bring your own water bottle;)

I AGREE TO PRINT THIS FORM OUT, FILL IT OUT AND SCAN AND EMAIL IN ONCE COMPLETE. EMAIL TO SERVICE@MILWAUKEEREIGN.COM.

FORM MUST BE FILLED OUT AND SENT A MINIMUM OF ONE MONTH BEFORE CLINIC AND PAYMENT MADE IN FULL TO SECURE DATE.
https://docs.google.com/spreadsheets/d/1i8VgILKxnP9WYPqL8nD4T_NNI9DIW2bAna8p3Z1oTgk/edit?usp=sharing

ALL ATENDEES MUST HAVE A SIGNED WAIVER BY PARENT IN ORDER TO PARTICIPATE:
https://docs.google.com/document/d/1tp34bUYCnPBs_QqNUlnQci31UzcVUbnloxIS4JXpXmU/edit?usp=sharing
DATE OF REQUEST - TODAY'S DATE *
MM
/
DD
/
YYYY
COORDINATOR NAME *
Your answer
COORDINATOR'S ADDRESS (WITH CITY/ZIP) *
Your answer
PHONE NUMBER *
Your answer
EMAIL *
Your answer
TROOP # AND SCHOOL NAME *
Your answer
GS CLINICS ARE SCHEDULED ON FRIDAYS 7-8:30PM, SATURDAYS 2-3:30PM SUNDAYS 3:00-4:30. THEY ARE BOOKED ON A FIRST COME, FIRST SERVE BASIS. PLEASE PROVIDE THREE SATURDAY'S YOU'D PREFER BELOW. WE WILL FOLLOW UP WITH APPROVED DAY WITHIN 7-10 BUSINESS DAYS. *
Your answer
I UNDERSTAND THAT EACH PARTICIPANT WILL BE $10 PER PARTICIPANT AND MUST BE PAID INDIVIDUALLY WITHIN 30 DAYS OF THE EVENT. WE CANNOT PROCESS ONE LUMP SUM FOR THE TROOP. *
Required
HOW MANY PARTICIPANTS DO YOU PLAN ON ATTENDING THIS EVENT? *
Your answer
I AGREE TO PRINT THIS FORM OUT, FILL IT OUT AND SCAN AND EMAIL IN ONCE COMPLETE. EMAIL TO SERVICE@MILWAUKEEREIGN.COM. FORM MUST BE FILLED OUT AND SENT A MINIMUM OF ONE WEEK BEFORE CLINIC. https://docs.google.com/spreadsheets/d/1i8VgILKxnP9WYPqL8nD4T_NNI9DIW2bAna8p3Z1oTgk/edit?usp=sharing *
I UNDERSTAND THAT ALL PARTICIPANTS MUST HAVE A WAIVER SIGNED BY PARENT IN ORDER TO PARTICIPATE. *
Required
ELECTRONIC SIGNATURE. *
Your answer
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