Camp Title

Month/Day/Year

/ /

Camp Fee

Requesting Family Discount

Yes     No

Camper’s Name

Birth Date

Age

Grade Entering Fall, ’08

Street Address

City, State, ZIP

Home Phone

Currently a Girl Scout?

Yes     No

GS Council (if appl.)

Troop Number

Cabin Mate Request*

*Must be reciprocated on the registration form of the requested cabin mate.  ONLY ONE cabin mate request will be accepted.

Family/Friends at Camp at the Same Time

Parent/Guardian Name

Day Phone

Evening Phone

Cell Phone

e-Mail Address

Payment Method

Select One Visa MasterCard Discover

Credit Card Number*

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Credit Card VIN Number

Expiration Date

Select Month January February March April May June July August September October November December    Select Year 2007 2008 2009 2010 2011 2012 2013 2014

Name As It Appears On Card