Girl Scout Council Sponsored Product Program Parent/Guardian Permission Form
2022 Cookie Program Please read and complete the information below and return the form to your troop leader for every registered Girl Scout who participates in the council product programs. Troop leader retains the form for their troop records
Street Address Line 2
State / Province
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New York State Driver's License Number
Please enter a valid phone number.
Girl Scout Information
Girl Scout's Name:
Girl Scout's 5 Digit Troop Number:
It is your responsibility to ensure you get and retain receipts for all products received and payments made to the troop.
Check each item to confirm you have read, understand and agree to the terms and responsibilities of participation in the Girl Scout Cookie Program.
I agree to accept full responsibility for all product and money received for the cookie program.
I agree to pay the cookie bill in full and on time to the troop leader/volunteer. It is understood and agreed that in the event any outstanding balance has to be referred to a collection agency or attorney for recovery, I will be fully responsible for all collection agency fees and attorney’s fees.
I understand the income from the product programs does not become the property of individual girl members. Girls, however, may be eligible for incentives and credits that may be applied toward Council sponsored camps, programs, uniforms, and membership.
I have reviewed the Girl Scout Internet Safety Pledge, Product Sale-Safety Activity Checkpoints, and Safety Tips for Product Sales (visit gswny.org and select forms).
The Girl Scout Law says, “I will do my best to be honest and fair.” I agree that my Girl Scout will not sell prior to the first day of the Girl Scout Cookie Program and I will provide adult supervision for her during the sale.
I confirm that I have read, understand, agree to and will comply with all of the above expectations, and financial responsibilities.
I understand that with the intentional typing of my full name in the box below I am consenting that the above information is true and correct. This will also be considered consent to your electronic signature for information on this document. Type full name:
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