2017 RESIDENT CAMP

REGISTRATION FORM
PLEASE PRINT IN BLUE/BLACK INK Please note that you may also elect to use the Council Online Registration Access (CORA)
available at gsoh.org if the attendee is a currently registered Girl Scout.

Please update my contact information

OFFICE USE ONLY
Girls name _______________________________________________ Age __________ Date received _________________________

Street address ___________________________________________________________ Financial assistance ____________________

City ______________________________________State ___________ Zip____________ Deposit ____________________________
Home phone ____________________________________________________________ Program fee _____ Balance Due _______

Caregiver daytime phone ___________________ Cell phone _______________________Confirmation sent ____________________

Caregiver daytime phone ___________________ Cell phone ______________________ Balance paid ________________________
Late fee ______________________________
Caregiver email address _____________________________________________________
Horse Yes No
Grade completed by summer _____________ Birthday ___________________________
Bus Yes No

SESSIONS 1ST CHOICE 2ND CHOICE IN-CASE OF EMERGENCY

Name of program_ ________________________________________________If custodial parents cannot be reached,
person to be notified in case of emergency:
Session dates ________________________________________________Name _________________________________
Riding bus ($45)? Yes _ No Yes No
Street address _________________________
If yes, select bus stop: Columbus _ Sunbury
Daytime phone _________________________
SPECIAL REQUESTS
Home phone __________________________
*Girls can request ONE buddy. Requests for multiple buddies will not be honored. Every
effort will be made to pair your camper with her buddy or troop, but it is not guaranteed.
Cell phone _____________________________
I wish to share a tent/cabin with _____________________________________
If custodial parents will be out of town during camp,
Are special accommodations needed? (Sign interpreter, brailled materials, etc.) where can you be reached:
_________________________________________________________________
Address ________________________________________
Registering for a travel camp? Child (SM 6-8) (MED 10-12) (LG 14-16)
Choose your size for your free T-shirt! City ___________________ State ______ Zip__________
Adult (SM) (MED) (LG) (XL) (2XL)
T-SHIRT SIZE (circle): Phone __________________________________________

Fees Amount Due MAKE CHECKS PAYABLE TO: Girl Scouts of Ohios Heartland Council, Inc. OR complete
below if you wish to charge your deposit to Visa, MasterCard, Discover or American
Resident Camp Deposit $40.00 = ___________ Express (deposit fee is non-refundable).
Bus fee (if applicable) $45.00 = ___________
VISA MASTERCARD DISCOVER AMERICAN EXPRESS
Total Included $ = ___________
$
Return to: Amount Account number (typically 16 digits)
Girl Scouts of Ohios Heartland Council, Inc.
Attn: Resident Camp
1700 Watermark Drive Expiration date Signature of card holder (required for credit card payments) Date
Columbus, OH 43215-1097
Fax: 614-487-8189 Billing address City State Zip
Email: customercare@gsoh.org