Girl Scouts of Southwest Georgia, Inc.

Program Registration for Troops

Please type or print. Incomplete registration forms will be returned and you will not be registered until a complete form and  deposit are received.

Name of Event________________________________________________________________________________

Date of Event_____________________________________  Troop #___________  Service Unit #_________

Age Level:  Daisy        Brownie  Junior       Cadette           Senior

Leader’s Name_______________________________________________________________________________

Leader’s Mailing Address_______________________________________________________________________

Leader’s Phone (day)___________________________Leader’s Phone (night)_____________________________

Names of Girls Attending Event:

1._________________________________________    11.____________________________________________

2._________________________________________    12.____________________________________________

3._________________________________________   13.____________________________________________

4._________________________________________    14.____________________________________________

5._________________________________________   15.____________________________________________

6._________________________________________   16.____________________________________________

7._________________________________________   17.____________________________________________

8._________________________________________   18.____________________________________________

9._________________________________________   19.____________________________________________

10.________________________________________   20.____________________________________________

Please indicate if any Girl Scout participant requires assistance with any of the following:

     ___ Wheelchair Accessibility          ___Physical Assistance          ___  Dietary

Explanation:_________________________________________________________________________________

Name of Accompanying Adults:   1)____________________________ 2)_________________________________

Name of First Aider______________________________________ Expiration Date________________________

Event Fee $____________________X_______________________=$___________________________________

  Enter 0.00 if free        # of girls             total amount due

Event Fee $____________________X_______________________=$___________________________________

  Enter 0.00 if free       # of adults             total amount due

Total Troop Amount Due $______________________ - ___________________=__________________________

  Deposit  Balance  Due         (enter 0 if no deposit)  (2 weeks prior)

Return this form to: GSSWG, 515 Pine Avenue, Albany, GA 31701