Wufoo

Which Girl-Only Event does your Girl Scout wish to attend (check one)
CIT Training-December 6th-8th 2013 (open to Girl Scouts in grades 10th, 11th, 12th) Lights, Camera, Action- January 17th-19th 2014 (open to Cadettes) Senior & Ambassador Retreat-February 17th-19th 2014 ( open to Seniors and Ambassadors) Just Breathe- February 28th-March 2nd 2014 (open to Cadettes) Curtain's Up-March 14th-16th 2014 (open to Juniors)
Registration Information
Girl Name First Last
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone ### - ### - ####
Cell Phone ### - ### - ####
Email
Date of Birth MM / DD / YYYY
Troop Number
Girl Scout Level
Parent/Guardian Name First Last
Weekday Phone ### - ### - ####
Evening Phone ### - ### - ####
Cell Phone ### - ### - ####
Parent's Email
Parent/Guardian Permission and Emergency Contact

Please list an emergency contact person
Name First Last
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Number ### - ### - ####
Cell Number ### - ### - ####
Relationship to participant
Parent/Guardian Initials
Payment Information

Girl-Only Event Fees
$95 per girl (without transportation)
$150 per girl (with transportation)

We cannot accept online payments at this time. Please mail checks to Girl Scouts of Greater New York, 43 West 23rd Street, 6th Floor, New York, NY 10010. To pay with Credit Card, please call Erica Mariano, at 212.645.4000 x233.
Total Amount Due $ Dollars . Cents
Payment Method *
Check (Make checks payable to the Girl Scouts of Greater New York) Credit Card (To pay with Credit Card, please call Erica Mariano, at 212.645.4000 x233)
Do Not Fill This Out

Wufoo

Registration Information

Parent/Guardian Permission and Emergency Contact