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Daisy program interest form
RSVP for more info about our Daisy program and a team member will get back to you!
Caregiver Name
*
First Name
Last Name
Caregiver Birthday:
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Email Address
example@example.com
Caregiver Ethnicity
Please Select
Hispanic
Non-Hispanic
I choose not to share
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
-
Month
-
Day
Year
Date
Girl's Ethnicity
Please Select
Hispanic
Non-Hispanic
I choose not to share
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?
*
Please Select
Participate in virtual e-troop meetings
Participate individually as a Juliette
Start a new troop
Add me to an existing troop
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.
Submit
Should be Empty: