Girl Scout Interest Form

Checkone:  New Member Reregistering




(if girl is 13 and up, otherwise use family email address)


 Both Parents Mother/Guardian Only Father/Guardian Only Other

Girl Scouts respects and welcomes people from all backgrounds and abilities. By completing the following optional question, you can help ensure community support and funding for Girl Scouts in your community. This information is used for statistical purposes only. Thank you for providing the information requested.

 American Indian or Alaskan Native Asian Black or African American Hawaiian or Pacific Islander White Other

 Yes No

 Address is same as girl




 Address is same as girl




We acknowledge that the registrant will make the Girl Scout Promise and accept the Girl Scout Law. The registrant has permission to join Girl Scouts.

*When participating in Girl Scout activities the registrant may be photographed for print, videotaped, or electronically imaged. 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. The images will be the sole property of either the local Girl Scout Council or Girl Scouts of the USA.

 I DO NOT give permission for the registrant to be photographed, videotaped or otherwise electronically imaged.

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