CampHERO 4 Women Registration

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First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Preferred Phone *

Email *

Emergency Contact Full Name *

Emergency Contact Phone Number *

Please list any dietary restrictions, medical conditions or allergies CampHERO 4 Women needs to know about: *

Media Release Statement: I give permission to be photographed/videotaped and allow CampHERO, Girl Scouts of WI - Badgerland Council and Girl Scouts USA to release said media for Girl Scout and camp publicity purposes. This includes print and web marketing/publications. Please note: If you do not give permission, you will not be allowed to appear in ANY photos including your own or those taken by other participants. you will be required to wear name tags that state "NO PHOTOS." *

I give permission

I do NOT give permission

Payment information: The registration fee is $50.00 and includes all program supplies, lunch, snacks and beverages. *

I will pay by check

I will pay by credit card

I will pay by cash

What is you pant size? (for fitting you in fire gear) *

What is your boot size in women's? (for fitting you in fire gear) *

All participants must initial and sign the Waiver, Release and Ideminification Agreement. You may print it and bring it with you or sign the copy that will be available on your arrival. https://drive.google.com/open?id=0B0_YLhrtcqaLSmNDV1E4R1VfYzQ

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