Juliette Cookie Program Participation 2025
To be completed by caregivers of Individually Registered Girl Scouts
Girl Scout's Name
*
First Name
Last Name
Girl Scout's Grade
*
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Caregiver's Name
*
First Name
Last Name
Caregiver's Email
*
example@example.com
Caregiver's Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please read and agree to each statement below.
I will support my Girl Scout(s) throughout the cookie program.
*
Yes
I understand that I will be contacted by phone and email throughout the cookie program.
*
Yes
I will respond to communication from council in a timely manner in order to ensure important cookie deadlines are met and complete any necessary JotForm submissions.
*
Yes
I verify that my phone number, email address, and mailing address are accurate. If any changes need to be made during the program, it is my responsibility let the Product Program team know.
*
Yes
I understand that my Juliette will earn proceeds in the form of council credit and are not eligible to receive troop proceeds. Council Credit can be used in the Girl Scouts of Central Indiana Shop, to register for council programs, to register for council summer camp, and for council facility reservations. Juliette proceeds are determined in a different manner than troop proceeds. Please see the Juliette Proceed Chart for proceed amounts.
*
Yes
I understand that I cannot return or exchange cookies, and I accept all financial responsibility for all cookies ordered from council.
*
Yes
As the caregiver of a Juliette, I am responsible for paying $6 per package of cookies ordered to the council.
*
Yes
I am responsible to turn in 50% of the cookie money owed to Girl Scouts of Central Indiana no later than February 26, 2025.
*
Yes
I am responsible to turn in 100% of the cookie money to Girl Scouts of Central Indiana no later than March 28, 2025.
*
Yes
I will safeguard all cookie funds, depositing cash promptly and not leaving it in a car, etc. where risk of theft could occur.
*
Yes
I understand that should any of my cookies or cookie money get lost, stolen, or damaged, I am still fully responsible for the funds and need to contact council immediately at 317-924-6827.
*
Yes
I understand that if I do not pay for the full amount of money due for cookies, I will be subjected to legal prosecution and any fees incurred. Failure to pay will also result in restrictions being placed on future Juliette participation and volunteer opportunities.
*
Yes
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: