Day Camp Volunteer Registration
form #871 • 04/19 • page 1 of 1
Day Camp _________________________________________________________ Date of Birth ____________________
Adult Name ________________________________________________________________________________________
Address ___________________________________________________________________________________________
City ________________________________________________ State _______________________ ZIP ______________
Home Phone ( _________ ) __________________________ Cell Phone ( ________ ) ____________________________
Email _________________________________________________________________ Gender _____________________
Send your fully completed registration form, accompanied by the completed form
“Day Camp Health History & OTC Medications”, to the address listed on the information
page of the day camp you are interested in. A completed form does not guarantee
day camp placement. Contact the appropriate day camp registrar with questions.
DO NOT mail day camp applications to the Girl Scout service centers.
For the following, see the description of your day camp
for availability and specific information.
I will volunteer: ALL WEEK or Monday Tuesday
Wednesday Thursday Friday
I would like to help with (check all that apply):
Daisies Brownies Juniors Girls 11-17 (PA/PAIT)
Under 5 yrs Boys Other (not in a unit)
Special Skills: Cooking Crafts Singing
Other ___________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
T-Shirt size: Sm Med Lrg X-Lrg
XX-Lrg Other ____________
If possible, do you want to be placed with your camper?
Yes No
Note: Some day camps do not allow parents to be placed
in a unit with their child.
Staff Children: List your children who will be attending day
camp by full name, program level and/or unit.
________________________________________________
________________________________________________
________________________________________________
________________________________________________
(See specific day camp information on age limits for staff
children.)
(if applicable)
Membership
I am a registered Girl Scout for the current membership year or I will register
myself online.
Please register me as a Girl Scout. I will pay the $25.00 for membership
dues. This will register me as a Girl Scout through September 30 of this
year (up to five months of membership).
I am a new member. I will pay the $35.00 extended-year membership
dues. This will register me as a Girl Scout through September 30 of next
year (up to 17 months of membership).
Acceptance and participation in summer programs is the same for everyone
without regard to race, color or national origin. As an equal opportunity organi-
zation, Girl Scouts is dedicated to diversity and fully supports the right of equal
access for girl and adult members with disabilities. Girl Scouts of Oregon and
Southwest Washington makes every reasonable effort to ensure this access.
We encourage you to voluntarily provide the following information on racial
background and ethnicity. This information will be used by Girl Scouts of the
USA for statistical purposes only and to help improve outreach efforts and
advance the Girl Scout Movement.
The registrant’s racial background is (please check as many as apply):
American Indian or Alaskan Native Asian
Black or African American White
Hawaiian or Pacific Islander Other
The registrant’s ethnic background is (please check one):
Hispanic or Latina Not Hispanic or Latina
Media Permission
I understand that when participating in Girl Scout activities I may be photo-
graphed for print, video or electronic imaging. I understand that the images
may be used in promotional and fundraising materials, news releases and other
published formats, and will be the sole property of Girl Scouts of Oregon and
Southwest Washington, its assigns or successors, or Girl Scouts of the USA.
I wish to opt in to GSUSA/GSOSW Texts Emails
I may NOT be photographed for Girl Scout publicity purposes
X __________________________________________________________
Signature of adult volunteer Date
All day camp volunteers must be registered Girl Scout members
for the current membership year, must have a current background
check, and must complete required trainings. If you will be paying
for this membership by credit/debit card or would like to apply for
financial assistance the easiest way to register for membership
and complete your background check is online at girlscoutsosw.org!
click to sign
signature
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