Program Aide Training (PAT) Application
Howard County Day Camp
June 18th – 22nd, 2012 9:00am - 3:30pm th
June 25th – 29th, 2012 9:00am - 3:30pm for Registered Girl Scouts entering 7 Grade in Fall 2012
Camp Ilchester in Ellicott City
http:www.gshcdc.org Open Registration - April 1 thru May 1, 2012
Applicant should complete this form.
Session 1 ( June 18th – 22nd, 2012 ) Session 2 ( June 25th – 29th, 2012 )
Our council offers one-day GSUSA Program Aide Training sessions during the calendar year (see “GS 411” for classes and locations).
This week-long training is intended for girls who want to specialize in outdoor service. It is helpful if they have attended the camp previously.
All three training components, “Basic” “Outdoor” and “Activity” are included in the training given at the Howard County Day Camp.
Forty-two applicants will be accepted for Session 1 (two units of 21 girls each) and twenty-one applicants will be accepted for Session
2. Participants are included in all theme-related activities, crafts, games and special presentations. At the end of the week, if all forms T
have been completed, the GSUSA Program Aide pin will be awarded along with a camp certificate of attendance. Each PA then earns
the patch by performing 25 hours of service at a location of her choice in the community at large. R
Name of Applicant __________________________________________ Phone No._______________
Street Address_____________________________________________ Apt. No.________________
City/Town____________________________________ State _____ Zip_____________________
E-Mail _________________________ Troop/Group No.____________ Service Unit No.__________
Leader/Adviser’s Name______________________________ E-Mail: __________________________
***** PAT Adult T-shirt size: (circle one) No exchanges -- if in doubt, order next larger size ***** G
Small (32-34) Medium (36-38) Large (40-42) X-LARGE (44-6)
Parent or Guardian Authorization –
I hereby grant permission for my daughter to attend the Howard County Girl Scout Day Camp in 2012 and authorize the Camp Staff to secure
necessary emergency care and treatment for my daughter should the need arise. My daughter is physically able to participate in all outdoor
activities including hiking and uneven terrain. If she appears ill, I will keep her home at will notify the camp. I agree to get my daughter to the
bus stop on time and stay with her until she gets on the bus. I further agree to be at the bus top at the end of the day to receive her.
Parent/Guardian Signature Date
Complete and Return:
Return this form to:
This form, signed by your parent/guardian
A Health History Record completed in black ink “Scottie” Corinna Watson
A Transportation/Photo Release completed in black ink 5487 Green Dory Lane
A Check for $85.00 made payable to: GSHCDC Columbia, MD 21044
A self-addressed #10 business envelope
2 – first class postage stamps (please paper clip to the self-addressed Phone 443-718-9336
Applications must be postmarked by May 1, 2012.
No refunds will be given after June 1, 2012.