MY25 Girl Scouts Series Program Cincinnati

This Girl Scout Series is a special opportunity for girls not currently in Girl Scouts!

Expand her world! As a Girl Scout, your girl will try new and exciting things. She’ll explore the outdoors, make friends, grow in confidence, and build skills that will help her in school and beyond.

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

Please take a few minutes and complete the following form. Thank you!

*Includes Girl Scout membership through September 30, 2025!
Once you fill out the form, you will receive an email that includes additional details . A member of our team will be in touch closer to the date of series to confirm the details of the event, and answer any questions you may have.

Caregiver information:

Caregiver Name*

First NameLast Name

Caregiver Birthdate*

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Caregiver Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Girl Information:

Girl Name*

First NameLast Name

Girl Birthdate*

Date

School*

Grade Level*

Girl Scout Program Location*

Anything else you would like to share?*

For Participation & Grant Information: Girl Scouts respects and welcomes people from all backgrounds and abilities. By completing the following information (as defined by the U.S. Census Bureau), you ensure support and funding for Girl Scouts in your community. Hispanic/Latina is defined as an ethnic¬ity, not a race, and therefore is reported separately. This information is used for statistical purposes only.

Girls Racial Background*

Girls Ethnic Background*

Thanks to generous donors who believe in girls, this program is free.

The Girl Scout membership year runs from October 1, 2024 to September 30, 2025. Membership is non-transferable.

Permission and Health History

Emergency Contact Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

List any medical conditions requiring treatment, ,medication, allergies (including food), or special needs. *

This health history is correct to the best of my knowledge, and the person herein described has permission to engage in all prescribed event activities except as noted. Please check the following to agree.*

Authorization for Treatment: If I cannot be reached in an emergency, I hereby grant permission to the physician selected by the event personnel to secure treatment, including hospitalization, if necessary.Authorization for Participation and Membership: I understand the nature of the activities in which my child(or children) is going to participate and give my permission for my child (or children) to: 1) engage in all program activities as planned by the Girl Scouts of Western Ohio and its affiliates, 2) for the Girl Scouts and/or its affiliates to use her picture(s) or video recording(s) and 3) if my daughter is not a registered Girl Scout I am willing to have my girl(s) become a registered Girl Scout member.I acknowledge that COVID-19 is an extremely contagious virus that spreads easily in the community. I agree to adhere to Girl Scouts of Western Ohio and state and local guidelines and mandates. I will take all reasonable precautions to limit potential exposure for girls, volunteers, and families, based on Girl Scouts of Western Ohio and state guidelines. I will hold GSWO harmless and waive all right to legal action, if my daughter contracts COVID through exposure at a Girl Scout event.

Approved Pick up Information: The adults listed below have permission to pick up my girl from this Girl Scout program (if appliccable)

Adult Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Adult Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Please verify that you are human*

Girl Scouts Series Program - Cincinnati