Girl Scouts Tarheel Triad Council, Inc. 8818 West Market St, Colfax NC 27235 Ph: 1-800-672-2148
Return your registration with the $12 annual membership dues to the leader/advisor or mail to your Girl Scout council. Reregistering GSUSA ID Number (if known ) Membership year 10/01/09 - 9/30/10 New Registration (First time registering)
Girl Information:
First Name Address Telephone Number (Home) Date of Birth (mm/dd/yyyy) Grade Middle Name City Email Name of School Number of years in Girl Scouts Last Name
Troop #
SU #
Custody
State Zip code
Mother/Guardian Information:
First Name Address (if different that girl) Employer) Phone Number (work) Middle Name City Occupation Phone Number (mobile) Last Name State Zip code
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Racial Information (check all that apply)
o o o o o o
American Indian / Alaskan native Asian African American Hawaiian or Pacific Islander White Other Ethnic Background
Father/Guardian Information:
First Name Address (if different that girl) Employer) Phone Number (work) Middle Name City Occupation Phone Number (mobile) Last Name State Zip code
o o
Hispanic or Latina Not Hispanic/Latina
The Girl Scout Promise On my honor, I will try: To serve God and my country, To help people at all times, And to live by the Girl Scout law. The Girl Scout Law I will do my best to be: honest and fair, friendly and helpful, considerate and caring, courageous and strong, and responsible for what I say and do, and to respect myself and others, respect authority, use resources wisely, make the world a better place, and be a sister to every Girl Scout.
Emergency Contact Information:
Name Phone (day) Phone (evening)
We acknowledge that the registrant will make the Girl Scout Promise and accept the Girl Scout Law. The registrant has our permission to join Girl Scouts. We understand that when participating in Girl Scout activities the registrant may be photographed for print, video, or electronic imaging. We understand that the images may be used in promotional materials, news releases, and other published formats for either the local Girl Scout councils or Girl Scouts of the USA. We acknowledge that the images will be the sole property of either the local Girl Scout council or Girl Scouts of the USA.
Signature of Parent/Guardian
Date
Family Partnership: Yes I want to help girls grow courageous and strong!
Information regarding the Family Partnership program is found on the back of this form.
I would like to contribute (please check one): $100.00 $50.00 Payment Method: $25.00 VISA $10.00 MC Other ______ AmEx
My check is attached
Card # Signature (Cardholder Name):
Send Patch?
Exp. Date
CVV #
No, Please put 100% of my donation toward Girl Scout Program
Yes (minimum donation of $10.00)
I understand that my voluntary, tax-deductible gift will help to support girls locally and will remain with Girl Scouts, Tarheel Triad Council, Inc. Please contact your employer to inquire about a matching gifts program. Your contribution could be doubled or tripled by your employer!!!
Girl Scouts of the USA is dedicated to providing equal access to membership for all girls and adults. Membership dues are not refundable or transferable to another person.
GIRL REGISTRATION 2010
Both Parents Mother/Guardian Father/Guardian Other (specify
CAMPAIGN 2009
Family Partnership makes it happen… Real People, Making a Real Difference!
Girl Scout Family Partnership Campaign 2009 April 1 - December 15
The Family Partnership Campaign is a way for Girl Scout families to support Girl Scouting and to invest in a rich and meaningful experience for their daughters. Your donation is more than charity, it’s an investment! An investment in what you believe in…that Girl Scouting builds girls of courage, confidence and character, who make the world a better place.
Each Girl Scout whose Family participates in the FAMILY PARTNERSHIP CAMPAIGN by making a minimum contribution of $10.00 will receive a participation patch.
Girl Scouts, Tarheel Triad Council, Inc. 8818 West Market Street Colfax, NC 27235
Questions: 336-274-8491
On my Honor, she will Thank YOU!