Program Pack Registration Form

Complete the form below to register your girl for the GSHNC Program Pack!
Caregiver Information
Caregiver Name*

First NameLast Name
Email Address*

Confirmation Emailyouraddress@service.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Phone Type*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Caregiver Birth Date*

MonthDayYear
Date
Caregiver Gender*
Caregiver Relationship to Girl*
Check if you were a Girl Scout. Daisy, Brownie or higher-it all counts.
Girl Information
Girl Name*

First NameLast Name
Girl lives at same address as the Caregiver.
Girl Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Grade*
If today is BEFORE August 1, enter the grade they are completing. If today is August 1 or after, enter the grade they will be going into.
School Attending*
Girl Birth Date*

MonthDayYear
Girl Email
Girls over 13 may provide an email address to also receive emails from GSUSA and GSHNC.
Girl Phone Number
Girls over 13 may provide a phone number to also receive texts from GSUSA and GSHNC.Format: (000) 000-0000.
Phone Type
Age
Demographic 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 girls in your community. Hispanic/Latina is defined as an ethnicity, not a race, therefore is reported separately. This information is anonymized and used for statistical purposes only.
Girl Ethnicity
Girl Race
Caregiver Ethnicity
Caregiver Race
Policies, Terms, and Conditions
I agree with the GSUSA Privacy Policy
I agree with the Terms and Conditions
I affirm that I understand and agree to adhere to Girl Scout Child Abuse Prevention policies and procedures.
I agree to the GSUSA Photo Policy (Optional)Email opt in - I agree to receive emails from GSUSA (Optional)SMS opt in - I agree to receive text messages from GSHNC standard data and text messaging rates apply (Optional)
Order Summary
Your Program Pack membership with Girl Scouts, Hornets' Nest Council includes:
- Girl Scout membership valid until 9/30/2027.
- Program Pack discounts:
  - Provides $10 off any* program hosted by Girl Scouts, Hornets' Nest Council.
  - Member pricing on Summer Camp sessions.
  - Member pricing on events with our program partners, such as Carowinds and the Charlotte Crown.
- Access to Girl Scouts, Hornets' Nest Signature programs including SheBiz and Cookie Rally.
*Note that we serve girls in kindergarten through 12th grade and most programs are designed for specific age ranges. Girls cannot attend programs that aren’t for their grade level.
Payment Amount
USD
Order Date

MonthDayYear
Date
Membership Fee

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USDProgram Pack Registration

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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Caregiver Information

Girl Information

Demographic Information

Policies, Terms, and Conditions

Order Summary