“Where in the World is Corky Camper”
Camp Shady Grove
Sponsored by Palmerton Service Unit in Girl Scouts of Eastern PA
Palmerton Memorial Park, Palmerton, PA
Dates: July 12th-16th, 2010 Times: 9:00 AM – 3:30 PM Cost: $95 per camper
Please mail registration form and payment to:
Camp Shady Grove, PO Box 286, Palmerton PA 18071
Questions or concerns? Contact Linda Finley at CampShadyGrove@live.com or 610-826-6723
Program Aides for Cadette, Senior, and Ambassador Girl Scouts
Program Aides are girls who are entering grades 7-12. This is a leadership-training program designed for girls who have attended
camp in the past and want to help plan camp and work with younger girls. Training will be offered before and during camp. If you
have already completed Program Aide training, you may assist at day camp. In either case, complete this registration form and mail
it in. There is no cost for this option.
I want to take Program Aide training! Yes_________ No________
I have already completed Program Aide training and want to assist at Camp Shady Grove! Yes________ No________
Camper First Name: Last Name: Parent/Guardian Email Address:
Address: City: State: Zip:
Age: Troop #: Grade in School Fall 2010:
Mother/Guardian Name: Home Phone:
Work Phone: Cell Phone:
Father/Guardian Name: Home Phone:
Work Phone: Cell Phone:
IF PARENTS/GUARDIANS CANNOT BE REACHED, ALTERNATE PERSONS TO NOTIFY IN
EMERGENCY
Name:
Relationship to Camper:
Home Phone: Work Phone: Cell Phone:
Camp Buddy: Girls must be in same Girl Scout level, and
registering for the same program. Only one buddy name permitted and both buddies should request each other.
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To help us be prepared to give the best care possible, please answer of the following questions (you may use
additional paper if needed):
Does your child have any medical conditions, learning differences, or special needs?
List all medications, allergies, and special diet needs.
Describe any special assistance necessary to participate in camp activities
PLEASE READ AND SIGN:
I give full permission for my camper to attend and participate in all phases of the activities at Camp Shady
Grove. I hereby give Camp Shady Grove of Girl Scouts of Eastern Pennsylvania, Girl Scouts of the U.S.A.,
my consent that any photographs, films, audio and visual tapes for which she posed may be used by Girl
Scouts of Eastern Pennsylvania, its assigns or successors, in whatever way they may desire, including
newspaper, audiovisual productions, television, radio, internet and other public relations purposes. I agree to
cooperate with all regulations and understand that my camper will abide by all camp rules, and if she does not
she may be sent home with no refund. I understand that the camp cannot be responsible for loss of valuables.
Parent/Guardian Signature Date
Payment: Please make checks payable to “GSEP Camp Shady Grove”
All camp fees, minus financial aid requested (GSEP form must be included), are to be paid in full at the time of
registration. Any refund request is not guaranteed and will be evaluated on case-by-case basis by the Camp
Shady Grove administrative team.
Non-registered Girl Scouts:
Please include $10 non-refundable membership fee with application
FEE SUMMARY
Program Fee $
Non-Girl Scout Fee $10 $
Total Fees $
Discount ½ fee if parent
is on staff -$
Financial aid request,
include GSEP form -$
Total $
Registrar use only Date Received: Check Number: Amount: