CLE Girl Membership Form (BSmith)

1
Already a Girl Scout & looking to RSVP? Click HERE

We Are Girl Scouts.

Girl Scouts bring their dreams to life and work together to build a better world.

Backed by trusted adult volunteers, mentors, and millions of alums, Girl Scouts lead the way as they find their voices and make changes that affect the issues most important to them.

Our Mission
Girl Scouting builds girls of courage, confidence, and character, who make the world a better place.
2
Please select your troop location.* This field is required.
Please Select
Please Select
MAGNET (1st & 3rd Saturday)
Earle B. Turner Recreation Center (EBT)
Mary B. Martin School
*I am interested in learning how to start a troop in my community
*Please send me a list of meetings and community events.
CCJD
3
Girl Name* This field is required.
First Name
Last Name
4
Girl Date of Birth* This field is required.
Month
Day
Year
5
Grade* This field is required.
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
6
School
7
Girl's Address* This field is required.
Street Address
Street Address Line 2
City
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
Primary Parent/Caregiver Name* This field is required.
First Name
Last Name
9
Primary Parent/Caregiver Email* This field is required.
example@example.com
10
Mobile NumberIf you would like to receive text reminders and/or notifications of GSNEO events
Please enter a cell phone number where we may reach you regarding Girl Scouts information.
11
Do you give Girl Scouts permission to send you text messages?*Data charges may apply.
YESNO
12
By checking this box, I consent to receive customer care and account notification text messages (SMS or MMS) from Girl Scouts of North East Ohio. You may opt-out at any time by replying STOP. For assistance, text HELP. Message frequency varies. Message & Data rates may apply. View TERMS (gsneo.org/terms) and PRIVACY (gsneo.org/privacy).
13
Is this a CMHA property?Note: If yes, Ms. Belinda or Ms. Kim will contact you for/with additional information.
YESNO
14
Parent/caregiver addressPlease enter "SAME AS GIRL" if it is the same.
Huge
Large
Normal
Small
Ok
Ok
15
Emergency Contact* This field is required.
First Name
Last Name
16
Emergency Contact Phone Number* This field is required.
Please enter a valid phone number.
17
How will your Girl Scout get home from the program?Select all that apply
After Care
Walk (child will be permitted to leave meeting site after meeting)
Picked up by caring adult (you will enter detail on next card)
18
Caring adult(s) that will pick Girl Scout above from meetings/programs:Please contact troop/group leader to add more.
Full Name of caring adult #1
Full Name of caring adult #2
Full Name of caring adult #3
Full Name of caring adult #4
19
I, on behalf of my child, give consent to the Girls Scouts of Northeast Ohio to use, publish, reproduce and distribute any photographs/recordings in which my child may appear solely for the purpose of publicity and promotion by the Girl Scouts of Northeast Ohio of its current and future events/activities/programs.* This field is required.Verify consent on next card.
I give consent.
I do not give consent.
20
Photo Release Consent* This field is required.
Powered by Jotform SignClear
21
I give my girl permission to be an official member of Girl Scouts of North East Ohio and have her dues paid with grant funding for the current year ending September 30.* This field is required.Please sign below.
Powered by Jotform SignClear
Should be Empty: