Girl Scouts Membership Form

Girl Scouts Membership Form

With Girl Scouts, the possibilities are truly endless. Discover all she can be and everything she can accomplish with the right tools and a safe space to shine—and work together to change the world!
Girl Name*

First NameLast Name
Troop Number: (If you don't know a specific troop number you can say "unsure" or "looking for a troop")*
Girl's date of birth*

MonthDayYear
Date
Grade Level in Fall of 2024 (Grade she's going into for the CURRENT ((2024-2025)) school year):*

Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade
Name of School Attending (no abbreviations, please)*
Zip code of School (if known)
Girl Ethnicity
Girl Race
Caregiver's Name*

First NameLast Name
Caregiver's relationship with girl*
Caregiver's date of birth*

MonthDayYear
Date
Caregiver Ethnicity*
Caregiver Race*
Caregiver Gender*

MaleFemaleI Choose Not To Share
Were you (caregiver) ever a Girl Scout? Daisy, Brownie, or higher, it all counts!

YesNoUnsure
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Are you interested in ways to help?

I'm ready to become a Volunteer now - Sign me up today! (Please select registration below)Don't register me yet, but I would love to learn more about becoming a Volunteer! Please contact me to discuss options and possibility of registering! (Please do NOT select caregiver registration below)Unfortunately I am not interested in volunteering. (Please do NOT select caregiver registration below)

Registration Selection - Please only select caregiver registration if you intend to volunteer: (If you select Financial Assistance you are not required to enter your payment information)*

Girl Registration (2210)Membership through September 30, 2025

$25.00

Girl Registration - Request Financial AssistanceMembership through September 30, 2025

$ Free

Caregiver Volunteer Registration (2210) - select if you're ready to be registered as a troop volunteer now with your girl!Membership through September 30, 2025

$25.00

Caregiver Volunteer Registration - Request Financial Assistance - select if you're ready to be registered as a troop volunteer now with your girl!Membership through September 30, 2025

$ Free

Enter coupon

Total

$0.00

Payment Method
Credit	Express

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

SMS messages from Girl Scouts of Central Indiana could include membership updates, event reminders, and opportunities to get involved. You may text “HELP” for help at any time or text “STOP” to cancel the SMS service at any time. As always, message and data rates may apply for any messages sent to you from us and to us from you. Message frequency varies. View our privacy policy here and SMS terms & conditions here.
Staff Member Name*

First NameLast Name
Should be Empty: