2019 R.O.Z.E Day Camp Registration Form
Please select the Service Unit you belong to:
Child's First Name
Your answer
Child's Last Name
Your answer
Registered Girl Scout
If no, visit www.girlscoutsrv.org to register.
Address
Your answer
City
Your answer
Zip
Your answer
Date of Birth (MM/DD/YY)
Your answer
T-Shirt Sizes
Grade in 2019-2020
Buddy's Name
Your answer
Please provide any other information you believe will assist our volunteers in providing the best experience for your participant.
Your answer
Permission
I give permission for my camper to attend day camp and participate in all activities, including overnights, which are part of the program, unless otherwise indicated. I agree to cooperate with all regulations and policies. I give permission for my camper to be photographed or recorded, and for River Valleys to use this material for publicity purposes. I will not send my camper if she becomes exposed to any contagious disease (including head lice), or if I do not consider her to be in good physical condition. I give permission for my camper to receive necessary medical treatment at area hospitals/medical centers or from the Day Camp Health Supervisor or designee. I will read and abide by communications from the day camp.
**SIGNATURE REQUIRED**
Parent/Guardian Signature
Your answer
Date
MM
/
DD
/
YYYY
Transportation
Riding the bus to camp?
If yes, please indicate the location you will be using.
Parent / Guardian Contact Information
Custodial Parent / Guardian Name:
Your answer
Custodial Parent / Guardian Phone #:
Your answer
Second Parent / Guardian Name:
Your answer
Second Parent / Guardian Phone #:
Your answer
Email
Your answer
Adult Able to Volunteer at Camp
Name of Volunteer
Your answer
Volunteer Registered as a Girl Scout
If no, visit www.girlscoutsrv.org to register.
T-Shirt Size
Volunteering Position
(First Aid, Unit Help, Bus Check In and Check Out, etc.)
Your answer
Please select the day(s) that you would be able to help.
Any disability or health concerns that must be considered for your placement?
Your answer
Volunteer Riding Bus
If yes, please indicate the location you will be using.
Registration Fee
Day Camp Fees (2019-2020 School Year):
Number of Cookie Credits Submitted
Your answer
Number of Volunteer Days
One child per household will receive a $5 discount for each day you volunteer.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service