R E G I S T R AT I O N

Name of day camp ____________________________________________

Session dates ________________________________________________

Buddy name* __________________________________________________

*Girls can request ONE buddy. Requests for multiple buddies will not be honored. Every effort will be made to pair your camper with her buddy or troop, but it is not guaranteed.

CAMP SESSION DETAILS

Use this form for all girls in grades K-6, PAs & APLs (Registration for all PAs/APLs is $15). Please note that you may also elect to use the Council Online Registration Access (CORA) available at www.gsoh.org if the attendee is a currently registered Girl Scout.

PLEASE PRINT IN BLUE/BLACK INK COMPLETE THIS ENTIRE PAGE

REGISTRATION FOR

(age 13+ & completed grade 7 by June 2016) (age 14+, completed grade 8 by June 2016 & completed PA 1) (age 15+, completed grade 9 by June 2016, completed PA 1 & 2.)

PA email address __________________________________________________________________

PA cell phone ____________________________________________________________________

D AY C A M P R E G I S T R AT I O N F O R M

Girl’s name _______________________________________________ Current Grade ____________________

Street address ______________________________________________________________________________

City _____________________________________________________ State ___________ ZIP_______________

Home phone _______________________________________________________________________________

Parent email address ________________________________________________________________________

Expiration date Signature of card holder (required for credit card payments) Date

Billing address City State ZIP

Amount Account number (typically 16 digits)

MAKE CHECKS PAYABLE TO: Girl Scouts of Ohio’s Heartland Council, Inc. OR complete below if you wish to charge your deposit to Visa, MasterCard, Discover or American Express (deposit fee is non-refundable).

VISA MASTERCARD DISCOVER AMERICAN EXPRESS

$

T-SHIRT SIZE (circle): Child (SM 6-8) (MED 10-12) (LG 14-16) Adult (SM) (MED) (LG) (XL) (2XL)

Fees Amount Due

Registration fee = ___________

Bus fee (if applicable) $50.00 = ___________

Total Due $ = ___________

If you register before the deadline, you will receive a t-shirt.

Make check payable to: Girl Scouts of Ohio’s Heartland Council, Inc.

Mail to:Girl Scouts of Ohio’s Heartland Council, Inc.1700 WaterMark DriveColumbus, OH 43215-1097

NEW MEMBER? All you need to do is attach the Membership Registration Form and your membership fee! The form can be found at www.gsoh.org.

Fax: 614-487-8189 Phone: 614-487-8101