Big Brothers Big Sisters + Girl Scouts Membership Registration Form

Big Brothers Big Sisters + Girl Scouts Membership Registration Form
Complete the Big Brothers Big Sisters + Girl Scouts Membership Registration Form and the information provided will be used to process your membership(s). Once processing is complete you will receive a confirmation email to begin onboarding for your new volunteer role. Please allow 5-10 business days for processing.

Here’s what you will get as part of this program:
- Free Girl Scout membership for you and your Little for the first membership year
- Girl Scout sash or vest (girl’s choice). See size chart .
- All patch insignia for sash or vest
- Three badges and badge activity sets
- Access to all Girl Scouts River Valleys programming
- Three FREE programs and four additional programs for a $5 deposit
Mentor "Big" Information
Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Gender *
Birth Date *

Month Day Year
Is the Mentor of Hispanic, Latino, or Spanish origin? *

Yes No Do not wish to answer
How would you describe the Mentor's ethnicity? *

Native American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Do not wish to answer
Juliette Girl Scout "Little" Information
Is the Little already registered with a Girl Scout troop? *

Yes No Unsure
Grade as of Fall 2021 *
Name *

First Name Last Name
Birth Date *

Month Day Year
Is the Little (Girl Scout) of Hispanic, Latino, or Spanish origin? *

Yes No Do not wish to answer
How would you describe the Little's (Girl Scout's) ethnicity? *

Native American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Do not wish to answer
School Attending *
Caregiver Information

Complete the form fields below for the Girl Scout Little's primary caregiver (parent, guardian, etc.)
Name *

First Name Last Name
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Is the caregiver of Hispanic, Latino, or Spanish origin? *

Yes No Do not wish to answer
How would you describe the caregiver ethnicity? *

Native American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Do not wish to answer
Birth Date (Enter 1/1/1900 if unsure) *

Month Day Year
Phone Number *

Area Code Phone Number
Email *
example@example.com
Welcome/Starter Kits
Each new mentor will have the opportunity to order a Welcome/Starter Kit for their "Little" with the option to have the kit delivered or picked-up at one of our two available Girl Scouts River Valleys Service Centers. All kits will include:
- Free Girl Scout membership for you and your Little for the first membership year
- Girl Scout sash or vest (girl’s choice). See size chart .
- All patch insignia for sash or vest
- Three badges and badge activity sets
- Access to all Girl Scouts River Valleys programming
- Three FREE programs and four additional programs for a $5 deposit
Would you like to order a Welcome/Starter Kit for your "Little"? *

Yes No
Please select the sash or vest option. *

Sash Vest
Select your Little's Program Grade Level *

Daisy (K-1) Brownie (2-3) Junior (4-5) Cadette (6-8) Senior (9-10) Ambassador (11-12)
Select Daisy - Junior size (Grades K - 5). *

Small Medium Large X-Large Plus Small Plus Medium Plus Large Plus XL
Select Cadette - Ambassador size (Grade 6 - 12). *

Small Medium Large X-Large 1X 2X 3X
For pick-up or delivery? *

Pick-up at Brooklyn Center or Saint Paul Service Center Delivered directly (no shipping fee)
Select the preferred pick-up location. *

Brooklyn Park Service Center Saint Paul Service Center
Select the preferred direct delivery address. *

Mentor Home Address Caregiver Home Address
Should be Empty:

Big Brothers Big Sisters + Girl Scouts Membership Registration Form

Here’s what you will get as part of this program:

Mentor "Big" Information

Juliette Girl Scout "Little" Information

Caregiver Information

Welcome/Starter Kits