E Council Online Registration

 Program Aide Training - Modesto Individual Registration
 
 Attending Girl (all fields required)
First Name
Last Name
Street Address
City
State
Zip
Mail Notices?
Telephone Number (Day)
  Email
Email Notices?
Grade
Emergency Contact (other than accompanying adult)
Phone Number (Day)
Phone Number (Eve)
Relation
 Attending Adult 
First Name
Last Name
Street Address
City
State
Zip
Telephone Number (Day)
Cell/Pager Number (Eve)
Email
  
 Parent/Guardian (all fields required)
First Name
Last Name
Street Address
City
State
Zip
Telephone Number (Day)
Cell/Pager Number (Eve)
Email
Type
 
 Troop / Pal / Fees/ Accessibility
Troop Number  (required)
Fee per Girl: $7.00    Wheelchair Accessibility
Fee per Adult: $0.00    Sign Language Interpreter
     Physical Assistance
     Other 
Photos, videos of my daughter MAY be used in Girl Scout Public Relations  Yes No