Summer Camp Registration Form - Girl Scouts Of Middle Tennessee - 2018
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12018 SUMMER CAMP
REGISTRATION FORM
Girl Scouts of Middle Tennessee | 4522 Granny White Pike, Nashville, TN 37204
Phone: (615) 383-0490 Fax: (615) 460-0238 Email:
PLEASE COMPLETE ONE REGISTRATION FOR EACH SESSION. A deposit of $100 must accompany each registration.
CAMPER INFORMATION
Last:
First:
Middle:
City:
State:
Zip:
Mailing Address: Street Apt #:
Grade for Fall 2018:
Age:
Phone: (
)
Troop #:
Date of Birth: ____/____/____
PARENT / GUARDIAN INFORMATION
First Name:
Last Name:
(Camp communication will be sent to this email, including confirmation, reminders
Parent’s Email:
and invoices. Please add as a safe sender.)
Address:
State:
Zip:
City:
(If different from camper)
Daytime Phone: (
)
Evening Phone: (
)
Cell Phone: (
)
PROGRAM CHOICES
If using a paper form, please submit a separate form for each camp session.
1st Choice:
Camp Sycamore Hills
Camp Holloway
Program:
Program Dates:
Program:
2nd Choice:
Camp Sycamore Hills
Camp Holloway
Program Dates:
3rd Choice:
Camp Sycamore Hills
Camp Holloway
Program:
Program Dates:
PAYMENT CALCULATIONS
Program Fee: $
Subprogram Fees*: $
Day Camp Breakfast ($15/week)
Day Camp Aftercare ($20/week)
Day Camp Overnight ($15)
Thursday Night Family Dinner ($5/person)
# people
Day Camp Transportation* ($75/week): $
*Subprogram and Transportation available
Subtract Deposit ($100 non-refundable per program): $
to Camp Holloway ONLY.
Subtract Discount ($100, $90, $65 or $30) if applicable: $
Trading Post Deposit ($25-$40 suggested): $
BALANCE DUE before May 4, 2018: $
Final payment is due May 4.
AUTHORIZATION OF USE OF BANK CARD
Please charge:
$ ______________
(VISA, MasterCard, Discover, American Express):
I am paying with:
Credit Card
Credit card number:
Expiration date:
Signature:
Date:
Card holder’s name:
CVV#:
Card holder’s mailing address:
City:
State:
Zip:
Card holder’s phone number: (
)
Evening phone: (
)
GIRL SCOUT INFORMATION
Member of Girl Scouts of Middle Tennessee
Not a Girl Scout
Girl Scout from another region
(Name of Girl Scout Council):
Name of sister attending camp: First:
Last:
CAMP BUDDY
Camp buddy preference (We will honor one request. Both girls must register for the same session):
First Name:
Middle Name:
Last Name:
T-shirt size: ______ YS ______ YM ______ YL ______ S ______ M ______ L ______ XL ______ XXL
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