Volunteer/CA Registration

VOLUNTEER REGISTRATION

(for ADULTS and CAMP AIDES)

AREA 9 & 12 DAY CAMP

8:30AM-4:30PM

JUNE 22-26, 2026
- Register one person at a time.
- Do not use this form for AITs or campers.
- Be prepared to provide health information (history, medications, tetanus date, etc.)
- Camp Aides are volunteers at camp but also legally children so this form may refer to them as a volunteer, camper, child, etc.
INDEX
Email Verification - THIS EMAIL ADDRESS IS HOW WE WILL COMMUNICATE WITH YOU (look for email from noreply@jotform.com)*

Volunteer Information
Type of Volunteer: (please select one)*

Camp AideAdult Volunteer
First Name*
Legal First Name
Preferred First Name or Camp Name*
Name you go by - this is the name we will use
Last Name*
Legal Last Name
Sex (legal)*
Preferred pronouns*
Grade in fall 2026*
Birth Date*

MonthDayYear
Are you a registered Girl Scout?*

YesNot Yet (Required prior to camp)
Troop Number*
Enter 000 for independent
Girl Scout Area*

912Other
Camp Aide Email*
Please enter the teen's email address!
Cell Phone Number (Camp Aide or Adult Volunteer)*
Camp Aides: please enter the teen's number
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Do you have any children attending camp?*

YesNo
Please list all your children attending camp:
Tagalongs (non-Girl Scout children of volunteers) are allowed to attend camp on the same days as an adult volunteer as long as they meet the criteria for the Pixie or Boys unit.

Pixies: Potty-trained; Age 3 - up to entering Kindergarten

Boys: entering 1st grade - up to age 11

There is a $20 fee for each pixie/boy, and you must complete a Camper Registration for each one.

Parent/Guardian Information
Camp Aide is in the custody of:*
Relationship to Camp Aide:
Mother/Guardian Name

First NameLast Name
Cell Phone Number
Email Address
example@example.com
Father/Guardian Name

First NameLast Name
Cell Phone Number
Email Address
example@example.com

Policies and Permissions
Health Information Privacy Statement From GSUSA

The health history form is for health care concerns at this camp only. All medical records will be held in limited access by the health care supervisor of this camp. Minimally necessary information may be shared with the camp staff / volunteers in order to provide adequate participant safety and health care. The health history form will be retained by GSK along with all forms / records with noted treatment for 7 years past the age of maturity of the participant. Access to the information will be limited. I have read the above procedures for handling health history information and I agree to the release of any records necessary for treatment, referral, billing or insurance purposes.
Health and General Permission Agreement*

CAMP AIDE: Parents or Guardian Statement - My camper has had a physical examination within the past 24 months and is in good health I give full permission for my camper to attend camp and participate in all activities (except as noted on this health history). The Girl Scouts of Kentuckiana is held harmless in the event of an accident. In the case of injuries, I give permission for medical treatment as deemed necessary. Permission is granted to use any pictures or video footage of my camper for Girl Scout promotional purposes. I agree that all information including immunizations is complete and up-to-date.ADULT: Volunteer statement - I am in good health and able to participate in all activities at camp (except as noted on this health history). The Girl Scouts of Kentuckiana is held harmless in the event of an accident in the case of injury, I give permission for medical treatment as deemed necessary. Permission is granted to use any pictures or video footage of me for Girl Scout promotional purposes.
Signature of Volunteer or Parent/Guardian (must be 18 or older to sign)*

Clear
Date

MonthDayYear
Date
Should be Empty:

Volunteer Opportunities

Volunteer Position Descriptions

Bus transportation to and from camp is FREE for adult volunteers.