2026 Mountaindale East Day Camp Registration Form

Camper's Legal Name*

First NameLast Name

Camper's Preferred Name (if different)

Birth Date

MonthDayYear

Camper's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Grade in Fall 2026

School in Fall 2026

Camper's age at the start of camp*

Camp buddy name(s)

Enter the name(s) of friends attending camp whom your camper would like to be placed with! We do our best to place everyone with one buddy but we cannot guarantee.

Payment and Cookie/Nut Credit

Below, select the program level and any add-ons (like bus transportation to and from SE Portland), then complete your payment. Payment of camp fees is required today, but if you would like to use your camper's Girl Scout Cookie/Nut Credit towards camp fees, please contact us for reimbursement.

Cancellation Policy
Before 4/31, 100% refund minus a $7 fee.
5/1-5/15, 50% refund minus a $7 fee.
After 5/15, we are not able to offer a refund.

Choose How Your Camper will Participate in Camp (Please complete this form for each child you are registering!) *

Full Camp Program with Bus Transportation

Daisy, grades 1

Daisies are Girl Scouts who will be in 1st grade in Fall 2026. We have room for a few Daisies who will be joining with Brownies.

$270.00

Junior, grades 4-5

Juniors are Girl Scouts who will be in fourth or fifth grade in Fall 2026.

$270.00

Outdoor Skills

The Outdoor Skills program consists of Girl Scouts who will be in 6th grade in Fall 2026.

$270.00

PAIT (Program Aide in Training)

The PAIT (Program Aide in Training) program is for Girl Scouts who will be in 7th grade and up in Fall 2026 and who completed Outdoor Skills. PAIT campers are accepted and will receive a link to an application so we can get to know them and their hopes for camp. 8th graders who are new to camp should register as PAITS.

$270.00

Program Aide (PA)/ Camp Aides (CA) grades 8+ (Requires Application)

Program Aides and Camp Aides are Girl Scouts who will be in grades 8 or higher in Fall 2026, and who have been accepted after submitting their application and letter of recommendation. DO NOT register for this program unless you have been notified that your camper's application has been accepted.

$145.00

Tag-alongs with Bus Transportation

Boys, ages 6-12 (With Adult Volunteer)

Boys can come to camp on days they have an accompanying adult volunteer!

$145.00

Tag-alongs, grades Pre-K (With Adult Volunteer)

Tag-alongs are Girl Scouts and aspiring Girl Scouts who are pre-K or K Daisy level or younger. Tag-alongs may only attend camp on days they have an accompanying adult volunteer.

$145.00

Enter coupon

Total

$0.00

My camper does NOT require bus transportationI have reserved a bus space by adding the "Bus Transportation" item to my cart aboveBus transportation was sold out, but I would like for my camper to ride the bus if possible!

MaleFemaleNon-binaryOther

She/HerHe/HimThey/ThemOther/Camper will tell us

T-shirt size*

What size t-shirt will your camper need? Camp shirts are worn daily to help us identify our groups!

Acceptance and participation in summer programs is the same for everyone without regard to race, color or national origin. As an equal opportunity organization, Girl Scouts is dedicated to diversity and fully supports the right of equal access for girl and adult members with disabilities. Girl Scouts of Oregon and Southwest
Washington makes every reasonable effort to ensure this access. The information below will be used by Girl Scouts of the USA for statistical purposes only and to help improve outreach efforts and advance the Girl Scout Movement. The registrant’s racial background is (please check as many as apply):

Hispanic or Latina/Latino/LatinxNot Hispanic or Latina/Latino/Latinx

Parent/Guardian #1*

First NameLast Name

Parent/Guardian #1 Cell Number*

Format: (000) 000-0000.

Home Number (if different)

Format: (000) 000-0000.

Parent/Guardian #1 E-mail*

example@example.com

Relationship to Camper*

Parent/Guardian #2*

First NameLast Name

Parent/Guardian #2 Cell Number*

Format: (000) 000-0000.

Home Number (if different)

Format: (000) 000-0000.

Parent/Guardian #2 E-mail*

example@example.com

Relationship to Camper*

Emergency Contact's Name*

First NameLast Name

Relationship to Camper*

Phone Number*

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

My camper is a registered Girl Scout for the current membership year.My camper is new or needs to renew her membership. I will register her/them online.

Troop Number

Please tell us your Girl Scout's Troop Number, if you know it!

How did you hear about our camp?

If "other," tell us how you heard about us!

Parent/Guardian Permission

As a legal guardian I give permission for the registrant to participate in all phases of camp activities and off-site trips. I understand that it is my responsibility to inform the day camp of activities that my camper may not participate in. I understand and agree to cooperate with all regulations. I will not allow registrant to attend if not in good physical condition. In an emergency, when the undersigned or other person named cannot be reached, I give permission for the camp authorities to take any emergency measure deemed appropriate. It is understood that all reasonable efforts will be made to contact the parent/guardian.

I understand that when participating in Girl Scout activities the registrant may be photographed for print, video or electronic imaging. I understand that the images may be used in promotional and fund raising materials, news releases and other published formats, and will be the sole property of Girl Scouts of Oregon and South- west Washington, its assigns or successors, or Girl Scouts of the USA.

YesNo

Please type your first and last name below as your electronic signature.

Mountaindale East Day Camp Registration

Camper Information

Bus Transportation Acknowledgment

Racial and Ethnic Background

Parent/Guardian Information

Emergency Contact Information