Smile Squad Registration

Contact Information
Name*

First NameLast Name
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
Shipping Address

(Where you would like the books and toothbrush kits sent)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
The free patch program for Girl Scouts is currently only available to girls in the Girl Scouts of Silver Sage Council.
Troop Information
Council *
Troop Number*
Please indicate the number of scouts in your troop:
Daisies:
Brownies:
Juniors:
Cadettes:
Seniors/Ambassadors:
Total Number of Girls:
Should be Empty: