Girl Scout Interest Form

Caregiver Name *

First Name Last Name

Caregiver Birthday:

Date

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Email Address

example@example.com

Caregiver Ethnicity

Caregiver Race(s)

American Indian or Alaskan Native Asian Black or African America Hawaiian or Pacific Islander White I choose not to share Other

Caregiver Gender

Female Male I choose not to share

Girl's Grade

Girl's Name

First Name Last Name

Girl's Birth Date

Date

Girl's Ethnicity

Girl's Race

American Indian or Alaskan Native Asian Black or African America Hawaiian or Pacific Islander White I choose not to share Other

School Attending

How would your girl like to participate in Girl Scouts? *

Use the space below to provide any additional information or ask questions. If your girl is joining an existing troop, enter the troop number in this field.

Girl Scout Interest Form

Girl Scout Membership Registration