2023 Camp Registration Form

Girl Scouts of Western Washington

Woodland Park Day Camp
BACK @ WOODLAND PARK!!!

2023

REGISTRATION IS NOW OPEN FOR SUMMER 2023 ON A FIRST COME FIRST SERVED BASIS.

Registration Form

for

	Camper	(Grade 1-6)
	PAT	(Grade 7 or 8, still needing PA Training)
	PA	(Grade 8-12)
	Boy/son	(Grade 1-6) - only for on-site volunteers
	Tagalong	Pre-k ages 3+ AND toilet independently

Grade is defined as the school grade the child will be in for fall 2023.

Complete one form for each camp attendee.

Attendee Name*

First NameLast Name

Please make note of this important information:

1. Camp is at Woodland Park this year.

2. All attendees (except boys and tagalongs) must be registered as a Girl Scout with GSWW for the 2022-2023 year. If not yet registered for this year, go to the GSWW membership tab.

3. !!! We will strictly follow the GSWW, city, county and state guidelines regarding COVID safety. These guidelines are continually changing and we don't know what they will look like at the time of camp.

Registering as*

Camper, entering Grade 1-6 in fall 2023PAT, entering Grade 7 or 8 in fall 2023 (for 8th graders who have not had PA Training)PA, entering Grade 8-12 in fall 2023.*Boy, entering Grade 1-6 in fall 2023. *For volunteers' male children only. Boys can be on site on the days their parent/guardian are on site volunteering.*Tag-along - pre-k *For volunteers only. Preschoolers ages 3+ AND independent toileting, can be on site on the days their parent/guardian are on site volunteering.

Grade of minor in fall 2023*

T-Shirt Size*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent 1 Name*

First NameLast Name

Parent 1 Best Phone Number*

Please enter a valid phone number.

Parent 1 Email *

example@example.com

Parent 2 name or second adult to use as emergency contact

First NameLast Name

Parent 2 Best Phone Number

Please enter a valid phone number.

In case of emergency, any other information to be able to contact a parent or guardian:

PA/PAT Questions

PA/ PAT email*

example@example.com

PA/ PAT camp name

Have you had Program Aide training and if so what year? Was your training through Woodland Park Day Camp or other?

If you have not had PA training, have you earned the Leadership in Action award (LIA)?

Medical Information

Birth Date of minor*

MonthDayYear

Does minor have any restrictions concerning physical activity?#*

YesNo

Does minor have any dietary restrictions?#*

YesNo

Does minor have any allergies, including to food?#*

YesNo

Does minor suffer from anaphylaxis?#*

YesNo

Does minor carry an EpiPen?#*

YesNo

Does minor carry an inhaler?#*

YesNo

Does this person have any other condition that may affect their experience or safety at camp (including but not limited to asthma, epilepsy, diabetes, migraines, hearing impairment, toileting challenges, ADHD, or mental health concerns)? #*

YesNo

Does this person have difficulty staying on task, have a tendency to run from caregivers, or find group situations challenging? (We would like to know so that we can do our best to keep her safe and have a positive camp experience.) #*

YesNo

# If you answered "YES" to any of the health questions above, please elaborate. If you answered no to each of those questions, please write "N/A"*

Does minor take over-the-counter medication?*

YesNo

Does minor take prescription medication?*

YesNo

Please list all over-the-counter and prescription medications and frequency.

My child’s immunizations are up to date in accordance with Washington State requirements for public schools:*

YesNo

If not, please indicate reasons:

In case of accident or injury, does this child have permission to take Benadryl or another antihistamine?*

YesNo

Primary physician name*

First NameLast Name

Primay physician phone number*

Please enter a valid phone number.

Primary physician office name or hospitial affiliation*

*CONSENT OF PARENT OR GUARDIAN FOR MEDICAL TREATMENT: I am the parent or guardian having legal custody of the child named above. I authorize all medical, surgical, diagnostic, and hospital care or procedures which may be performed or prescribed for my child by a licensed physician or hospital, when efforts to contact me are unsuccessful and when deemed immediately necessary or advisable by the physician to safeguard my child’s health. I waive my right of informed consent to such treatment. I will take full responsibility for all charges that occur. Girl Scout insurance is secondary to your primary insurance.

*I know of no reason (s), other than the information indicated on this form, why my child should not participate in activities except as noted.

*I have reviewed the Girl Scouts of Western Washington policy on administering medication to a minor. If applicable, I will take with the camp director about any medication my child needs during the day and I will complete the appropriate permission forms.

* I agree to instruct my child to observe rules and regulations governing the activities. I understand camping programs involve inherent risks and possible injury because of the nature of the activity, even when conducted in a safe manner. I give permission for my child to attend camp and participate in all phases of the program including off-site activities and related transportation. I understand my child’s good health is required before she can attend camp.

*The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact, by contact with contaminated surfaces and objects, and possibly in the air. People reportedly can be infected and spread the disease even if they do not show any symptoms. Girl Scouts of Western Washington (“GSWW”) is committed to taking precautions to mitigate that risk as well as to following applicable federal, WA State, local and GSUSA COVID-19 directives and guidelines. Our council is also committed to having in-person activities as allowed and in accordance with those mandates. GSWW’s operations and programs occurring while COVID-19 is circulating in our community may expose our members, volunteers, and employees to the risk of infection. GSWW cannot prevent you from becoming exposed to, contracting or spreading COVID-19 while attending (which includes being present in any capacity) any GSWW in- person programming. Therefore, any interaction with others in connection with in-person programming may expose you and your family to and increase your risk of contracting or spreading COVID-19. GSWW has put in place preventative measures to reduce the spread of COVID-19 at its inperson programming; however, GSWW cannot guarantee that you will not become infected with COVID-19.

By participating in these in-person activities, participants will be viewed as:
1.) Understanding that COVID-19 is a highly contagious virus, easily spread including through in-person contact;

2.) Acknowledging that GSWW cannot guarantee that infection will not occur;

3.) Choosing to accept the risk of contracting COVID-19 for the participant and their family in order to attend the inperson activity; and

4.) Agreeing to release GSWW from responsibility in the event of COVID-19 infection. Participants who do not agree to these statements should not join in-person GSWW activities.

5.) I understand, as a camp attendee, I will be “Girl Scout Ready”, pursuant to the Girl Scout Ready self-screening tool, 30 minutes prior to camp, and will not attend camp and immediately inform the Camp Director if I am not “Girl Scout Ready”

PLEASE REVIEW AND BECOME FAMILIAR WITH THE "GIRL SCOUT READY SELF-SCREENING TOOL" AT THIS LINK.

I have read and agree to the statements above. I understand the information and agree to allow this person to participate in camp. **

Yes

Media Permission: When participating in Girl Scout activities, I (or the person I am registering) give consent to be interviewed, photographed, videotaped, or electronically imaged for the purposes of promotional materials, news releases, or other published formats for either the local Girl Scout councils or Girl Scouts of the USA. The images will be the sole property of the local Girl Scout council or Girl Scouts of the USA. I hereby release and hold harmless the local Girl Scout council and Girl Scouts of the USA from any claim arising from the use of these images. (Please noted that we take group pictures and distribute them to the campers in that unit.)*

I agreeI disagreeYou have my permission to take group photos of this camper and distribute them to camp attendees.

More Questions

What is this person's current grade ?*

What grade will this person be in fall 2023 (Just to make sure we ask again since it saves a lot of work to make sure we have the right information.) ?*

What is this persons current school?

What school will this person attend in fall 2023?

If this girl is in a troop, please list the troop number:

Is this girl registered as a Girl Scout member for the 2022-2023 school year?*

YesNoUnsure

NOTE: Camp attendees must be a registered Girl Scout member for the 2022-2023 year. If not, please go to the GSWW website to activate your registration. (Does not apply to boy/pre-k tagalongs.)

Will you be using Cookie Dough to cover some of this person's camp costs?*

YesNo

List 16 digit on card

Exp. Date

CVV code

If you're using cookie dough, do not process your payment on the website. When we receive this registration, our registrar will contact you for your Cookie Dough information and payment.

Are you requesting financial assistance for camp costs?*

YesNo

Please list names of siblings of this person who are registering for camp, and if they are a camper, PA, PAT or boy.:

For campers currently in grade K-5 only, if this person has a preferred camp buddy, please include their name(s) here.

When two campers (currently in grades K-5) name each other as buddies, we do our best to ensure they are placed in the same unit for the week. We do not guarantee they will be placed together.

CAMPER RELEASE FOR CHECK-OUT

In Girl Scouting, the health and safety of your camper is our most important concern. For this reason, we ask that you complete the form below and read the information that follows very carefully. This procedure was implemented to ensure the safety of all campers at day camp.

Please provide us with the following information about who will be picking up your camper from day camp. Campers will only be released to adults listed on this Camper Release for Check-out form.

The adult listed on this form must show PHOTO IDENTIFICATION and will be required to sign for the camper they are picking up. For your camper's safety, there will be no exceptions.

All changes must be made in writing to the Camp Director with the parent/guardian's signature.

INCLUDING YOURSELF, list the full name of each person to whom this person CAN be released during checkout*

This person is a PA/PAT who has permission to sign herself out.*

YesNo

List the names of anyone who is NOT PERMITTED to sign out this camper:

Please inform the people listed above that they will be required to show photo identification at pick up location, and sign for your camper before she will be released.

Campers will not be released to anyone who:

1. Is not listed on this form.

2. Does not have photo identification.

Signature

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

By signing below, I certify this health history is correct and the minor I registered is able to safely participate in all prescribed activities except as noted.

By signing below I certify all information I provided is correct. I affirm I have read, understood, and agree to the statements of this form. I confirm the information listed in the Camper Release Check Out Form.

I understand that if I have questions, at any time, regarding any of the policies and procedures, I will contact the Girl Scouts of Western Washington Customer Care Team at (800) 541-9852 or email CustomerCare@girlscoutsww.org.

Please print name*

First NameLast Name

Signature of Parent/Guardian*

Date signed*

Date

Is the parent/guardian planning to volunteer at least two full days at camp? If so, please complete a volunteer registration form. Thank you.*

YesNoProgram Aide or Program Aide in Training and their siblings registration

After hitting "Submit", you will have the option to register any other family members attending camp. After you have registered every family member who will attend camp, you will be able to go to the Payment Form. After payment, your registration is complete.

(Families who indicated they will apply for Finanicial Assistance do not need to complete the Payment Form at this time.)