Interest Indicator

Yes! I want to be a Girl Scout!

Please note: this is not a membership form. A Girl Scout staff person or volunteer will use the information collected to contact you regarding membership registration and local Girl Scout troops, groups and activities. Thank you for providing all of the information requested.

Girl's Name:

Grade:

Age:

School Attending:

School/Rec. Center Near Home:

Adult's Name:

Relation to Girl:

Address:

City:

State:

Zip:

Home Phone:

Work Phone:

E-mail:

Availabiltiy
Check the best times when you and/or your girl can participate:

Monday	After School	Evening
Tuesday	After School	Evening
Wednesday	After School	Evening
Thursday	After School	Evening
Friday	After School	Evening
Saturday	Morning	Afternoon	Evening
Sunday	Morning	Afternoon	Evening

Please select your preferred troop/group meeting location?

Volunteering
Girl Scouting depends on the help of adult volunteers. Please check the ways you might be able to help. Training is provided for all volunteers.

Troop Leader or Co-Leader
Assistant Leader
Driver/Trip Chaperone
Leader's Meeting Representative
Special Events/Trip Planner
Cookie Manager
Camping/Outdoor Specialist
Work with Adults Only
Trainer
Other: