Girl Scouts During School Registration Union Springs Elementary School
GIRL INFORMATION
Girl Name
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
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31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Ethnicity
*
Please Select
American Indian or Alaskan Native
Asian
Black or African American
Hawaiian or Pacific Islander
White
Other Races
I choose not to share
Grade
*
Please Select
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
School
*
Union Springs
CAREGIVER INFORMATION
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Email
*
example@example.com
The girl listed above has my permission to participate in the Girl Scout Program at her school.
*
Yes
Media Permission: When participating in Girl Scout activities my child may be photographed or recorded on video. Images may be used in promotion materials, news releases, and other published formats for either the local Girl Scout Council 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.
Check here to opt out
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