PA Registration 2024

Program Aide Registration

Registration Options

Program Aide (8th-11th Grade Fall of 2024) ($125.00)
Leader-in-Training (12th Grade Fall of 2024) ($125.00)

GSUSA Membership

OPTIONAL GSUSA Membership (valid through September 2024) ($25.00)
All participants must be a registered member with GSUSA. We highly recommend you register as a member directly through GSUSA. You can register through http://www.girlscoutsosw.org/ under "Become A Girl Scout."
If you select this option, we will register you as a Girl Scout before camp. All participants will be checked if they are registered through GSUSA.

Has the registrant completed a camp or council sponsored PA training session? (PAIT year at camp)

Yes
No
Unsure

Program Aide Information

Legal Name

Preferred Name

Email Address

Phone Number

Address

Date of Birth

Pronouns (optional)

T-Shirt Size

Grade (Fall of 2024)

School Attending

Buddy Name (Note: PAs are not guaranteed a buddy. Most unit PAs will not be placed with a buddy.)

Does the registrant have permission to attend the PA Overnight on Saturday, July 27?

PA Overnight Permission

Does the registrant have permission to attend the Thursday Overnight on Thursday, August 1st?

Thursday Overnight Permission

Can the registrant be photographed for Girl Scout publicity purposes?
I understand that when participating in Girl Scout activities the registrant may be photographed for print, video or electronic imaging. I understand that the images may be used in promotional and fund raising materials, news releases and other published formats, and will be the sole property of Girl Scouts of Oregon and Southwest Washington, its assigns or successors, or Girl Scouts of the USA.

Photo Release

All PAs and LITs must also complete the PA application questions in addition to this registration form.

Please complete the Google Form through
https://forms.gle/Hvo7aQXo4ociyKnH9

Parent/Guardian Information

Note: Please do not use an "auto-fill" feature for your information. This may cause your camper's name to be replaced with yours.

Parent/Guardian #1 Name

Parent/Guardian #1 Cell Number

Parent/Guardian #1 Home Number

Parent/Guardian #1 Work Number

Parent/Guardian #1 Email

Parent/Guardian #2 Name

Parent/Guardian #2 Cell Number

Parent/Guardian #2 Home Number

Parent/Guardian #2 Work Number

Parent/Guardian #2 Email

Emergency Contact Information

Emergency Contact #1 (Not Parent/Guardian)

Phone Number

Work Number

Relation

Emergency Contact #2 (Not Parent/Guardian)

Phone Number

Work Number

Relation

Health Information

Describe Allergies

Describe

Registrant will be carrying an Epi-Pen

Registrant will be carrying an Inhaler

List any restictions concerning physical activities

Registrant requires medication at camp

Please Describe

Current on Tetanus?

Date of last booster (year)

Specify any dietary restrictions for overnight

Over-the-Counter Medications
According to our Day Camp Protocols and Health Care Procedures, our health care staff can administer certain types of over-the-counter (OTC) medications. In order for your camper to be able to receive these, we need to have parent/guardian approval.

(Unchecked boxes means camper MAY NOT receive that medication.)

Weight of child for dosage purposes:

Family Medical/Hospital Insurance Carrier

Policy or Group Number

WoW Day Camp operates 100% by adult volunteers. Volunteering is a rewarding, fun-filled experience. Please consider being an adult volunteer at camp. If you would like to volunteer, please complete a volunteer registration form.

Would you like to volunteer at camp?

Yes
No
Maybe

Acceptance and participation in summer programs is the same for everyone without regard to race, color or national origin. As an equal opportunity organization, Girl Scouts is dedicated to diversity and fully supports the right of equal access for girl and adult members with disabilities. Girl Scouts of Oregon and Southwest Washington makes every reasonable effort to ensure this access. The information below will be used by Girl Scouts of the USA for statistical purposes only and to help improve outreach efforts and advance the Girl Scout Movement.

The registrant’s ethnic background is (please check one)

Hispanic or Latina
Not Hispanic or Latina
I choose not to share

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