COOKIE PROGRAM CAREGIVER AGREEMENT

COOKIE PROGRAM CAREGIVER AGREEMENT
My Girl Scout, Girl Scout Name* , a member of Troop Number, Troop Number* has my permission to participate in the 2026 Girl Scout Cookie Program.
Troop Cookie Manager Email Address*
example@example.com
Please read and agree to each statement below:
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Caregiver Information
Caregiver Name*

First NameLast Name
Caregiver Date of Birth:*

MonthDayYear
Date
Caregiver Cell No. *
Please enter a valid phone number.
Caregiver Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Caregiver Email Address*
example@example.com
Place of Employment*
Work Phone Number*
Please enter a valid phone number.
Text MessageEmailPhone Call
Caregiver Signature*

Clear
Date*

MonthDayYear
Date
VOLUNTEER OPPORTUNITIES
Cookie booth chaperone (2026 membership required)Cookie delivery assistantOther
Should be Empty:

Please read and agree to each statement below: