CAT & Jr. CAT Application

CAT & Jr. CAT Application
Select your level
Which level are you
Applicant & Parent Information
Girl Scout First Name
Girl Scout Last Name
Girl Scout Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Troop/Group Number
Current Grade
Parent 1 Email
example@example.com
Street Address
City
State
Zip Code
Parent 1 First Name
Parent 1 Last Name
Parent 2 First Name
Parent 2 Last Name
Parent 2 Email
example@example.com
Health Form
Girl Scout First Name
Girl Scout Last Name
Girl Scout DOB

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Girl Scout Address
Street Address, Line 2
City
State/Province
Zip/Postal Code
Girl Scout Troop/Group #
Parent 1/Caregiver First Name
Parent 1/Caregiver Last Name
Parent 1/Caregiver Street Address
Parent 1/Caregiver City
Parent 1/Caregiver State
Parent 1/Caregiver Zip
Parent 1/Caregiver Email
example@example.com
Parent 1/Caregiver Primary Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent 2/Caregiver First Name
Parent 2/Caregiver Last Name
Parent 2/Caregiver Address
Parent 2/Caregiver City
Parent 2/Caregiver State
Parent 2/Caregiver Zip
Parent 2/Caregiver Primary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent 2/Caregiver Email
example@example.com
Emergency Contact 1 First Name
Emergency Contact 1 Last Name
Emergency Contact 1 Relationship to Girl Scout
Emergency Contact 1 Primary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2 First Name
Emergency Contact 2 Last Name
Emergency Contact 2 Relationship to Girl Scout
Emergency Contact 2 Primary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Physician First Name
Physician Last Name
Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Is the girl covered by family medical/hospital insurance?
If so, carrier or plan name
Policy or group number
Name of insured
Relationship to girl
Health conditions checklist

Other
If other please specify
Specify
Additional health information including disabilities and/or special needs
Are your Girl Scouts immunization records up to date
Medications checklist

Other
If other please specify
Food allergies checklist with

Other
If other please specify
Other necessary information
Signature of Parent 1/Caregiver with date
Signature of Parent 2/Caregiver with date
CAT Application

(We want your CAT to fill this out)
Location
Phone Number for the group me
Please enter a valid phone number.Format: (000) 000-0000.
Email for Camp Communication
example@example.com
Additional Email
example@example.com
T-shirt Size
Email Address (CAT’s Own)
example@example.com
GroupMe Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Are You a Returning CAT?
Were You a Jr. CAT?
Have You Worked at Other Camps?
Age Groups Interested In
Activity Stations Interested In
What are some leadership experiences you have?
What are some skills do you have?
What are some of your hobbies, interests, and clubs
Enter your camp name
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Jr. CAT Application
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Jr. CAT Email Address
example@example.com
GroupMe Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email for Camp Communication
example@example.com
Where would you like to be stationed and what are your qualifications?
Additional Email
T-Shirt Size
Camp Name
Agreements
I have reviewed her Health History Record and confirm that all the information is current and correct. I have provided any medications that my daughter will need to take in the original container with written instructions on when they are to be dispensed. I give permission to the person trained in First Aid, or another adult in charge of the activity to administer the medicine as needed. I have reviewed her Health History Record and confirm that all the information is current and correct. I have provided any medications that my daughter will need to take in the original container with written instructions on when they are to be dispensed. I give permission to the person trained in First Aid, or another adult in charge of the activity to administer the medicine as needed.
Signature
For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I hereby consent and agree to the following: I acknowledge that I am eighteen (18) years of age or older. I hereby grant to Girl Scouts of Greater Atlanta and others working for Girl Scouts of Greater Atlanta or on its behalf, and each of its respective licensees, successors and assigns (each a “releasee”), a one-time use of the photo in association with the article. One time use would be royalty free with unlimited right to distribute and publish and exhibit the photo together with the article. Use of the photo for any other use is not authorized. 2. I shall have no right of approval, no claim to compensation and no claim (including, without limitation, claims based upon invasion of privacy, defamation or right of publicity) arising out of any use, alteration, blurring, illusionary effect or use in any composite form of my name, picture, likeness and voice. I agree that nothing in this release will create any obligation on Girl Scouts of Greater Atlanta to make any use of the Media or the rights granted in this release. I hereby release and hold harmless releasees from any claim for injury, compensation or negligence resulting or arising from any activities authorized by this release and any use of the media by Girl Scouts of Greater Atlanta.
Signature
I agree that I or my child will behave by the Girl Scout Law, be respectful to other campers, leave all alcohol, tobacco, drugs at home. Campers agree to leave electronics put away during camp time.
Signature
I have read and understood the refund policy
Signature
Should be Empty:

CAT & Jr. CAT Application

Select your level

Applicant & Parent Information

Health Form

CAT Application

Jr. CAT Application

Agreements