Child and Adult Registration Form

Participation Permission
I give my permission for the listed below to attend Day Camp and participate in planned program and in all camp activities. I will not hold Girl Scouts - Wilderness Road Council responsible for any illness or injury that might occur at Day Camp.
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
to attend Day Camp and participate and to engage in all camp activities. I will not hold Girl Scouts - Wilderness Road Council responsible for any illness or injury that might occur at Day Camp.
Signature of Parent or Guardian*

Powered by Jotform SignClear
Date

MonthDayYear
Date

Payment

Please enter the number of campers for each option
Camper
Input # of Campers Attending
Pixie/Boy
ONLY for Staff Children
Extended Day
Input # of Campers Attending Extended Day
Adult Volunteer T-Shirt
I will be using Cookie Dough

YesNo
Total Cookie Dough
Numbers Only
I will be using Scholarship Funds

YesNo
Amount of Scholarship
Numbers Only
Total Due
Auto Calculated
Total Due
Auto Calculated
When you hit SUBMIT, you will be taken to another screen and asked to sign your registration form by clicking on the button at the bottom of the page. It will then take you to the payment page. You will be required to type in your TOTAL DUE.
Should be Empty:

Registration Form - Staff and Campers