2021 Camp Barren Ridge Camporee Registration Form

Welcome GS Volunteer!

We are so glad that you have chosen to volunteer at the Girl Scout Camp Barren Ridge Camporee. Girl Scout Camp is designed for you to make new friends and to interact with the girls in playing games, making arts and crafts, earning patches and badges, and most importantly HAVING 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 up 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!

GS Volunteer Information

GS Volunteer Name *

First Name Last Name

Volunteer Date of Birth *

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

Volunteer 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

Volunteer Email

Emergency Information

Emergency Contact's Name *

First Name Last Name

Relationship *

Phone Number *

Area Code Phone Number

Alt. Phone Number

Area Code Phone Number

HEALTH HISTORY INFORMATION

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.).

Are you taking any medications? *

Yes No

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

Media Permission: I hereby give consent that my 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

Volunteer Attestation: By signing this form, I am agree to follow all GSK COVID Camp Guidelines, demonstrate the GS Promise and Law, and follow all GSK Safety Guides. *

Clear

2022 Camp Barren Ridge Camporee Registration Form