Program Aide Day Camp Interest Survey

Thank you for choosing to be a Program Aide for a Girl Scouts of Citrus Council Day Camp. After completing this registration and submitting it, we will verify your training and camp availability. Please note that this form does NOT register you for a summer camp. We are using it to check on your availability and training.

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* 1. Please confirm the level of leadership training taken as well as internship status.

Program Aide - Grades 6 -8

Already Completed my Internship

This is my Internship Week

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* 2. Please indicate the date your leadership training was taken.

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* 3. Camp Weeks of Choice
(Based on Availability)
Prices for PAs to attend camp is $100/camp. All Day Camps will be held at Celia Lane Little House. If a camp is not listed, the camp is full.

	Choices
1	1 Choices menu

Other (please specify)

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* 4. CAMPER'S INFORMATION

Camper's First Name

Camper's Last Name

Camper's Date of Birth

Camper's Current Age

Camper's Current Grade

Troop #, Juliette or Not Registered

Girl Scout Level Fall 2014 - Summer 2015

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* 5. T- Shirt Size

Youth Medium 10-12

Youth Large 14 -16

Adult Small

Adult Medium

Adult Large

Adult Extra Large

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* 6. Parent / Guardian Information

Parent/Guardian’s First Name

Parent/Guardian’s Last Name

Street Address

City, State

Zip Code

Home Phone w/Area Code

County of Residence

E-mail Address

Work Phone w/Area Code

Cell Phone w/Area Code

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* 7. Additional Parent/Guardian Information

Parent/Guardian’s First Name

Parent/Guardian’s Last Name

Work Phone w/Area Code

Cell Phone w/Area Code

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* 1. Please confirm the level of leadership training taken as well as internship status.

Question Title

* 2. Please indicate the date your leadership training was taken.

Question Title

* 3. Camp Weeks of Choice (Based on Availability)Prices for PAs to attend camp is $100/camp. All Day Camps will be held at Celia Lane Little House. If a camp is not listed, the camp is full.

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* 4. CAMPER'S INFORMATION

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* 5. T- Shirt Size

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* 6. Parent / Guardian Information

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* 7. Additional Parent/Guardian Information

* 3. Camp Weeks of Choice
(Based on Availability)
Prices for PAs to attend camp is $100/camp. All Day Camps will be held at Celia Lane Little House. If a camp is not listed, the camp is full.