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Girl Membership
GIRL SCOUT MISSION
Girl Scouting builds girls of courage,
confidence, and character, who
make the world a better place.
FUN WAYS TO PARTICIPATE
:
(check all that interest you)
� Camp: Connect with nature.
Choose a camp by day or overnight.
� Events: Focus on half or full day
events to share your passions.
� Series: Explore your interests
over a few sessions in a way that fits
your schedule.
� Travel: Pack your bags. Travel
across town or around the world!
� Troop: Have fun on a regular
basis with your Girl Scout sisters.
� Virtual: Interact virtually with
Girl Scouts everywhere.
YES! I would like to make a
donation today that directly
benefits girls in our area. Enclosed
is my tax-deductible donation
in the amount of: (check one)
� $500 � $250 � $150
� $100 � $50 � $25
� Other $
PAYMENT INFORMATION:
Membership Fee: $ 15
Donation: $
Total Attached: $
� Cash � Check*
� Amex � Discover
� Visa � MasterCard
� Other
Name on Credit Card
Credit Card #
Expiration Date
Signature
Date
*Make checks payable to Girl Scouts
THANK YOU FOR
SUPPORTING GIRL SCOUTS!
Learn more about Girl Scouts at
www.girlscouts.org.
Return this registration form,
along with GSUSA membership
fees to your local council. Fees
are non-refundable or transfer-
able to another person.
Join the global network of 2.7 million Girl Scouts
Membership Year through 9/30/2017
Name: First Middle Last
Address Apartment
( )
City State / Zip Code Girl Home Phone
( )
Girl Cell Phone (only if 13 and older) Girl E-Mail Address (only if 13 or older) I wish to opt in*: � Texts
Girl Scouts respects and welcomes people from all backgrounds and abilities. By completing the following information (as defined by the
US Census), you ensure support and funding for girls in your community. Hispanic/Latina is defined as an ethnicity, not a race, therefore is
reported separately. This information is used for statistical purposes only.
Date of birth: (mm/dd/yyyy) / / # of years as a Girl Scout: School grade in Fall 2016:
Name of school:
Custodial care:
� Both Parents
� Mother/Guardian Only
� Father/Guardian Only
� Other
She is: (check all that apply)
� American Indian or
Alaskan Native
� Asian
� Black or African American
� Hawaiian or Pacific Islander
� White
� Other (please specify)
� I choose not to share at
this time
She is Hispanic or Latina:
� Yes
� No
� I choose not to share
at this time
� Address is same as girl
Parent/Guardian (1) First Name Middle Last
Address
Employer Occupation
( ) ( )
Home Phone Business Phone
( )
Cell Phone E-mail Address I wish to opt in*: � Texts
� Address is same as girl
Parent/Guardian (2) First Name Middle Last
Address
Employer Occupation
( ) ( )
Home Phone Business Phone
( )
Cell Phone E-mail Address I wish to opt in*: � Texts
Media Permission
When participating in Girl Scout activities
(I or the person I am registering) give consent
to be interviewed, photographed, videotaped,
or electronically imaged for the purposes of
promotional materials, news releases, or other
published formats for either the local Girl
Scout Councils or Girl Scouts of the USA. The
images will be the sole property of the local
Girl Scout Council or Girl Scouts of the USA.
I hereby release and hold harmless the local
Girl Scout Council and Girl Scouts of the USA
from any claim arising from the use of
these images.
� I wish to opt out at this time.
The Girl Scout Promise
On my honor, I will try:
To serve God and my country,
To help people at all times,
And to live by the Girl Scout Law.
When making the GS Promise,
individual members may sub-
stitute wording appropriate to
their own spiritual beliefs for
the word “God.”
The Girl Scout Law
I will do my best to be
honest and fair,
friendly and helpful,
considerate and caring,
courageous and strong, and
responsible for what I say and do,
and to
respect myself and others,
respect authority,
use resources wisely,
make the world a better place, and
be a sister to every Girl Scout.
*By signing here and
checking the circles
above, each signee
(and on behalf of the
Girl, as applicable)
agrees to receive
auto-dialed inform-
ational or marketing
text messages at the
cell number above,
understanding such
consent is not
required to join.
Council Code: Service Unit/Team: Group/Troop:
PATHWAY OF ENTRY: � Camp � Event � Series � Travel � Troop � Virtual
Check one: � New Member � Renewing Member GSUSA ID (if known)
PARENT/GUARDIAN INFORMATION DEMOGRAPHICS GIRL INFORMATION
ADMIN
USE
Signature of Parent/Guardian Date
Signature of Parent/Guardian Date
I/We acknowledge that the registrant will accept and abide by the Girl Scout Promise and
Law. The registrant has permission to join Girl Scouts.
PERMISSION