Girl Scouts Of Western Washington Special Camp Session Registration Form printable pdf download

Girl Scouts of Western Washington

Special Camp Session Registration Form

Core Camps, Partners Camps, Family Camps

Check

for the information and cost.

Use a separate form for each camp session.

Complete both sides of this form. Be sure the camper meets qualifications for the program you choose.

Return with payment to: Girl Scouts of Western Washington, PO Box 770, DuPont, WA 98327-0770.

Fax: (253) 473-0969 Email:

Adult in charge of group

Home Phone (

)

Address

Cell Phone (

)

Adult Contact’s e-mail

City

State

___ Zip

_____

□

Change of address:

Yes

(please list email address where you would like the camp information to be sent)

Troop#

Event Name/Location

Event Date(s)

# Child(ren)

# Adults

One session per form, please.

Please tell us if anyone attending the event has any special dietary or physical needs that would affect participation

Name: _____________________________ Need: ________________________________________________________________________

(Use another page if more space is needed, or for additional names.)

non-refundable $25 deposit is required

for all

Session Fee

registrations, including those that qualify for

Total Attendees

X $

Financial Assistance.

(child)

(Session Fee)

Total Attendees

X $

Please see financial assistance information online

(adult)

(Session Fee)

scouts/join/financial-assistance.html

Non- members

(add $15 per person)

(Complete membership information on side 2)

Please see Camp Brochure or

I’d like to make a tax-deductible donation

for Session Fees.

to send other girls to camp (optional)

One registered Girl Member is required per

Payment enclosed

Family Camp or Partners registration. All Core

($25 per person deposit minimum)

Camp participants must be registered members.

Total Attendees Requesting FA

_____

(Attach Financial Assistance Request forms to this registration)

:  Check #

 Cookie Dough Card _______________________

Payment Information

________

 Visa

 MasterCard

 American Express

 GSWW Gift Card Number

Amount authorizing to be charged (either cookie dough, credit card or GSWW Gift Card) $

Please Print Name of Card Holder

________

Signature of Card Holder

______

Card #

_____

___

____

Exp. Date

V Code

Cancellation Policy

Written notification of all changes and cancellation is required. Send notice to the camp registrar at the DuPont Girl Scout Center. Email to

is acceptable and preferred. The deposit is non-refundable/non-transferable. If written cancellation is received at

least four weeks before the beginning of the session, all camp fees already paid except the nonrefundable $25.00 deposit may be refunded.

Fees paid for transportation will be refunded only if written notice of cancellation is received prior to the four week cancellation deadline. In the

event of a medical condition or family emergency that requires cancellation, the fee, minus the deposit, may be refunded at the discretion of the

camp director, or if space is available, a transfer to another session may be arranged. The explanation for cancellation must be received in

writing. Confirmation from a medical provider is required for a medical cancellation. NOTE: For Core Camp Only: If a participant cannot attend,

substitutions may be made up to four weeks prior to the start of the session.

Girl Scouts Of Western Washington Special Camp Session Registration Form

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