2021 Camp Barren Ridge Camporee Registration Form

Welcome Camper!

We are so glad that you have chosen to attend Girl Scout Camp Barren Ridge Camporee. Girl Scout Camp is designed for you to make new friends, play games, make arts and crafts, earn patches and badges, and most importantly HAVE FUN! This camp will take place rain or shine! Our theme this year is 'Hot Fun in the Summer Time' with a a focus on aquatic activities and soaking in the great outdoors!

Camp will be July 14-16, 2022, with an overnight camp-out both nights. It will be held at the Girl Scouts of Kentuckiana Camp Barren Ridge. This camp property is located at: 399 Girl Scout Rd, Glasgow, KY 42141. Girl Scouts of all levels will be campers. Scouts Brownie level and higher can stay both nights. Daisies will need to be dropped-off and picked-up each day.

We are excited to be at this property as it offers water access to Barren River Lake so the girls can particpiate in kayaking, canoeing, swimming, as well as archery, Teams Course, hiking trails and more!

Camper Information

Camper's Name *

First Name Last Name

Camper's Date of Birth *

Please enter at MM/DD/YYYY (example- 01/01/2008).

Grade in the Fall of 2022 *

Scout Level Fall 2022 *

Camper's T-Shirt Size *

Please select your camper's t-shirt size.

Address *

Street Address

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

Camper's Email

Parent/Guardian Information

Name *

First Name Last Name

Home Number *

Area Code Phone Number

Cell Number *

Area Code Phone Number

E-mail *

Emergency Information

Emergency Contact's Name *

First Name Last Name

Relationship *

Phone Number *

Area Code Phone Number

Alt. Phone Number

Area Code Phone Number

List all persons who are allowed to pick-up your scout (photo ID will be required when picking up scout). *

HEALTH HISTORY INFORMATION

Camper's Name *

Immunizations are up to date and a copy of records can be provided upon request. *

Yes No

Allergies *

	Check all that apply
Animals
Food
Insect Sting
Latex
Medicine/Drugs
Plants
Pollen
Hay Fever
Peanut/Nut
No allergies

If you checked any of the allergies above, please provide and explanation of what happens when this allergy occurs. *

Illness & Conditions *

	Check all that apply
Asthma
Bleeding/Clotting Disorder
Diabetes
Heart Disease/Defect
Hypertension
Musculoskeletal Disorders
Seizures
Ear Infection
Celiac Disease (Gluten Issues)
Lactose Intolarate
No illnesses or conditions

Other Health Conditions *

	Check all that apply
Bed Wetting
Constipation
Contact Lenses/Glasses
Fainting Spells
Hearing Impairment/Hearing Aid
Motion Sickness
Nosebleeds
Sickle Cell Disease
Sleep Disturbances
ADD/ADHD/ODD
Special Diet
No other health conditions

Please list any other illnesses or conditions that your camper may have.

If you checked any of the above allergies, illnesses or conditions, please provide the nature of the illness/condition, any restricted activity, dietary needs, treatment (Epipen, Benadryl, etc.).

Has your camper started menstruating? *

Yes No

Is the camper taking any medications? *

Yes No

If your camper is taking any medications (even over the counter) please list them here, along with the dose and frequency.

Please check the medications that you allow to be administered to your scout if the need arises. *

Tylenol Oral antihistamine ibprofen Antibiotic ointment

Camp Barren Ridge will cost $100. This covers all camper expenses, including patches, badges and t-shirts.

Please check payment method(s): *

Cash/Check (mail to Amber Huggins, 605 Broadway Ave., Franklin, KY 42134 GSK Rewards Venmo @GirlScoutCamp717

Overnight Permission: I hereby give permission for my scout to stay overnight July 14th and 15th at the Camp Barren Ridge Camporee. I understand that to stay overnight that my camper must be a Brownie level or higher AND be comfortable in staying away from home. I also understand that once my camper is at camp she is there to stay unless there is an emergency.

Clear

Media Permission: I hereby give consent that my scout's first name, image and likeness as show in videos, photographs, and/or electronic images, and/or audio recordings of her voice may be used by GSUSA, in whatever way they desire including; television, social media, emails, etc., furthermore I hereby consent that such photographs, recordings, electronic images, audio recordings, etc., shall be GSUSA's sole property, and they shall have the right to sell, duplicate, reproduce and make other uses of such photographs, recordings, electronic recordings, audio recordings et. as they may desire free and clear of any claim whatsoever on my part.

Clear

Camp Attendance Permission: By signing this form, I am giving consent for my scout to attend Camp Barren Ridge Camporee, and that all information in this registration is accurate. My scout will follow all the GSK rules and demonstrate the GS Promise and Law *

Clear

2022 Camp Barren Ridge Camporee Registration Form