2011 GS-TOP Day/Twilight-Summer Extreme Guide

Day/Twilight Campand Summer ExtremeGuide

2011

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Camp Information 2

Summer at a Glance 6

Day/Twilight Camp Registration Information and Deadlines 3

Other Information 4 Day/Twilight Camp Sessions 11

Summer Extreme Adult Volunteers 3

Registration Information and Deadlines 3Other Information 4

Summer Extreme Events 14

Financial Assistance Form 23

Center SectionSummer Volunteer Application

Day/Twilight Camp Registration FormSummer Extreme Girl Registration Form

Summer Extreme Adult/Sibling Registration Form

Contents

Find it FasterKnow what type of activity your daughter wants to do this summer? Use Focus Icons to search by type of program.

Outdoor Education

Healthy Living

Science/Technology

General Session

Arts/History

Grade levels are listed by color to make it easier to spot the programs your daughter can participate in!

Daisy Brownie Junior Cadette Senior Ambassador

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Girl Scouts of Texas Oklahoma Plains welcomes you to the Summer Activity Guide!Welcome to another summer full of wonderful activities for Girl Scouts to enjoy all summer long. Your daughter will have a great time while learning skills, enjoying new experiences and meeting new friends.

Important Dates to RememberApril 1 Placement begins. (Registrations received prior to or on April 1 will be included in a random draw for placement.)June 6 – August 1 Day/Twilight Camp and Summer Extreme season.

*Registration for all summer activities closes seven days prior to activity start date.

Volunteers Make It Happen

Day/Twilight Camps• Rooted in Girl Scout traditions.• Licensed by the State of Texas. Camps offered in this booklet meet the highest standards of safety set by Girl Scouts of the USA and the Texas Youth Camp Safety Act.• Day/Twilight camps are an outdoor experience. Girls will spend most of the day outside exploring and enjoying nature. • Operated by trained volunteers. No employed staff.• Volunteers are needed in order to serve as many girls as possible.*• Extra bonus for Day/Twilight Camp volunteers – your Girl Scout daughters attend for free!• For all volunteers over the age of 18, successful completion of a Criminal Background Check and a 90-minute “Play It Safe” training are required for appointment to this volunteer position (training is provided).

*If you are interested in volunteering, please contact the Volunteer Camp Director (listed in the camp description in the Day/Twilight section of this book) and submit the Summer Volunteer Application with your registration. The staff contact person for Day/Twilight Camps is Megan Ibarra, 817-735-5326 or [email protected].

Summer Extreme • Partners with resources throughout our communities.• Provides high quality programs.• Needs Girl Scout volunteers. Every Summer Extreme event MUST have at least two adult Girl Scout volunteers present. • For all volunteers over the age of 18, submission of a Summer Volunteer Application and completion of a Criminal Background Check are required. • Provides wonderful activities for girls and families: o Events for individual girl participation (not designed for whole troops). o My Family and Me – events for girls and their family members Each girl registration for Summer Extreme family activities must be accompanied by at least one adult (18 years or older) registration form; in cases of siblings, one adult may register with more than one girl. o My Buddy and Me – events for girls and an adult (usually a parent or adult family member).

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Registration Information and Deadlines

When• Placement of registrations begins on April 1.• After April 1, registrations will be processed daily first come, first placed, until the sessions are full or until the close date. • Registration will close seven days prior to the event date or first day of camp, with no additions except those on the waiting list. • No on-site registrations!

How• Separate registration forms are required for each girl and each event/camp.• Please submit one check for all Summer Extreme events that your daughter is registering for and a separate check for all Day/Twilight Camp sessions she is registering for.• Registrations are not accepted by phone or email unless the fee is paid with a credit card or with Cookie Bucks. • No on-site registrations or payment will be accepted .• Be sure to completely fill out both sides of each form and include signature and full payment.• Incomplete registrations will not be processed and will be returned. • The immunization history must show dates, including month and year. Terms like “up to date,”or “current” or “on file with the school” cannot be accepted. For religious or health exemptions, contact the Day/Twilight Camp Registrar at 817-737-7272 or 800-582-7272.

Out-of-Council Girls• Girl Scouts who are not currently registered as a member of Girl Scouts of Texas Oklahoma Plains may attend Summer Extreme or Day/Twilight Camp.• Registration for out-of-council girls will begin on April 8.• An additional fee of $5 will be added for all Summer Extreme events.• An additional fee of $10 will be added for all Day/Twilight camps.

Day and Twilight Camp General InformationRegistration forms and fees for activities listed in this Summer Guide, should be sent to:

Girl Scout Center 4901 Briarhaven Rd., Fort Worth, TX 76109Office: 817-737-7272 or 800-582-7272Fax: 817-732-1261

Summer Extreme Registrar: Laura Jones at 817-735-5311 or 800-582-7272 or [email protected]/Twilight Camp Registrar: Nicole Durham at 817-735-5345 or 800-582-7272 or [email protected]

Fees and PaymentGeneral Information• Girls who are not registered Girl Scouts must add a $12 membership fee with their event/camp registration.• Full payment must accompany the registration form and can be paid in cash, by credit card, check, money order, or with Cookie Bucks. • Cookie Bucks: $1 fee = $1 in Cookie Bucks.• Cookie Bucks may be used to pay for girl fees only. Family and adult fees may not be paid using Cookie Bucks. • Cookie Bucks will not be refunded if cancellation procedures are not followed.• If sisters are registered Girl Scouts in Girl Scouts of Texas Oklahoma Plains and both participated in the 2011 Cookie Sale, a one-time transfer of any number of cookie packages from one sister to another may be made.

Specific Information for Day/Twilight Camps• Fees include a large Day/Twilight Camp patch for the first camp attended and a Sun or Moon patch for each additional camp attended. • Cookie Bucks: 400 packages = one full Day/Twilight Camp session

Specific Information for Summer Extreme• Fees include a large Summer Extreme patch for the first event attended and a smaller patch for each additional event attended.

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Financial Assistance We believe all girls should have the opportunity to benefit from the Girl Scout program experience. We recognize that it may not be possible for all families to afford registration fees. Depending on available funding, a limited amount of financial assistance may be available to cover part of, or the entire fee.• An applicant for financial assistance must be a registered Girl Scout in Girl Scouts of Texas Oklahoma Plains. • Financial Assistance applications will be processed on a first-come, first-served basis. All requests for financial assistance will receive a response. Applications are included in back of this book.• Only one application for financial assistance can be awarded each year, per girl.

Session Placement and ConfirmationWithin two weeks of placement, parents will receive a written confirmation postcard or letter of placement or wait list status.

Confirmation letters will include additional information and directions to the camp location and a full address for Summer Extreme events. Please do not call to confirm placement or wait-list status before April 15, to allow time for processing initial registrations.

If you do not receive a confirmation card or letter at least seven days prior to the event start date, please contact the registrar’s office to verify placement or wait list status.

Waiting Lists and Cancellations

Waiting Lists• If a session is full, parents will be notified that their daughter has been placed on a wait list.• If space becomes available, parents will be contacted. If a girl cannot be placed, her fee will be refunded.

Cancellation Policy• To cancel a registration for a summer event, contact the council office registrar either by phone or email.• If a participant cancels before registration closes, a refund of the activity fee, less 20%, will be given.• If a participant cancels after the registration close date, no refund will be given.• If a girl does not attend an activity, a refund will be made for medical reasons only. A written request for a refund, accompanied by a doctor’s statement, must be received within 30 days of the activity missed.• If the camp health supervisor sends a camper home for medical reasons, and the camper does not return to camp for the remainder of the time, a refund will be made on a pro-rated basis.• If a girl leaves the event or camp early for any reason other than for a medical reason, no refund will be made.• If a girl is placed on the waiting list and cannot be placed, a full refund will be issued.• If the event is cancelled, a full refund will be issued. Reasons for cancelling include, but are not limited to, severe weather or not reaching the minimum number of participants.

Other Information

Adult VolunteersVolunteers for Day/Twilight Camp and Summer Extreme events must be registered adult members of Girl Scouts of Texas Oklahoma Plains and complete the Summer Volunteer Application found in this booklet. Submit the Summer Volunteer Application form with your daughter’s registration form.

Specific Information for Day/Twilight Camp Volunteers• A Day or Twilight Camp informational session is required for all camp volunteers and will be provided at no cost. Adult volunteers will be notified by the Camp Director regarding dates and times of session.• Volunteering has a bonus! Girl Scout daughters of full-time Day/Twilight Camp volunteers attend for free. • School-age boys or preschool children of volunteers can also attend by registering using the Day/Twilight Camp Registration/Health form. Please send a program fee of $2 per child for boys or pre-schoolers. There may be a small additional fee to cover activities and meals for boys and pre-schoolers. Camp Directors will notify volunteers as needed.

Specific Information for Summer Extreme Volunteers• Except for family events, adults are not required to stay for Summer Extreme events. • If your schedule permits or requires you to stay at the activity due to travel times or other reasons, please consider volunteering to help at the event. Your help is needed!

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nDay/Twilight Camp Program Aide OpportunitiesOne of the excellent Girl Scout Leadership Experience opportunities for older girls is to become a Program Aide. Program Aides are trained girls ages 12 – 17 who make a commitment to teach skills to younger Girl Scouts. Day/Twilight Camp provides a wonderful opportunity for Program Aides to accumulate service hours while honing their leadership skills.

Girls who apply to be a Day/Twilight Camp Program Aide must have completed a Basic Program Aide course plus either: 1. Program Aide Outdoor Skill Builder camping weekend or;2. Program Aide Day/Twilight Camp Specialization. (Program Aide trainings are listed at www.gs-top.org/events and in the leader enewsletter, The Runner)

Program Aides should complete a Day/Twilight Camp Registration form and a Summer Volunteer Application. Place both applications in an envelope marked “Day/Twilight Camp Program Aide,” and mail or take to the council office. Camp Directors make decisions on how many Program Aides each camp needs and will contact the applicant within two weeks of placement. Because Program Aides are “working” much of the day, no fee is charged for the girls to participate and earn service hours.

Summer Extreme TagalongsA tagalong is a child not registered in the activity, such as a sibling of any age. Tagalongs are not covered by Girl Scout insurance and change the dynamics of the event, taking away from an equal learning environment for the girls and/or the event facilitator. Tagalongs may not attend Summer Extreme events.

TransportationTransportation to and from summer activities is the responsibility of the parent or guardian.

Girls with Special NeedsPlease inform us of any special adaptations or accommodations necessary to assist your daughter’sparticipation in summer program. Be sure to attach a detailed note with the registration forms.

Questions

Day/Twilight CampContact Megan Ibarra at 817-735-5326 or 800-582-7272 or [email protected] or call the Camp Director listed for the camp of your choice.

Summer ExtremeContact Angel Moore at 817-735-5314 or 800-582-7272 or [email protected]

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ALL GRADE LEVELSDate Title Page6/4 My Family and Me: Fishing 15

6/6-10 Pecan Grove Twilight Camp - Exploring Animals 11

6/6-10 Granbury Twilight Camp - Things Every Princess Needs to Know! 11

6/13-17 Twilight Trails Twilight Camp - Survivor 11

6/18 My Family and Me: Fishing 15

6/20-24 Sunshine Meadows Twilight Camp - Blast to the Past! 11

6/27-30 Wooded Acres Twilight Camp - Campwanahavalotafun! 12

7/11-15 Wildlife Trails Day Camp - Swimming Away 12

7/17 My Buddy and Me: Ceramics 21

DAISYDate Title Page6/4 Master of Disaster 15

6/11 Child Safety Program 16

6/12 My Buddy and Me: Klay Kids 17

6/25 My Buddy and Me: Badge of Honor 19

6/26 My Buddy and Me: Yoga 19



7/23 Master of Disaster 15

BROWNIEDate Title Page6/4 Master of Disaster 15



6/16 My Space 17

6/17 Pioneer Sampler 17


6/25 My Buddy and Me: Badge of Honor 19




7/21 My Buddy and Me: Me and My Shadow 21

7/22 Fanciful Flights 21


JUNIORDate Title Page6/4 Balloon Twisting - Beginners 14


6/10 Balloon Twisting - Beginners 14


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6/11 My Buddy and Me: Candle Making 17


6/15 My Buddy and Me: Graffiti Crew 17

6/16 My Space 17

6/17 Balloon Twisting - Intermediate 14


6/18 Horse Fan 18

6/23 Kayak Basics 18

6/23 Kayak Techniques 18


6/25 Babysitter Training 19

6/25 Glass Fusing 19

6/26 BeadDazzled 19


6/29 Graffiti = Art or Vandalism? 20


7/7 Kayak Basics 18


7/8 Balloon Twisting - Advanced 14


7/9 My Buddy and Me: Body Mist 20


7/16 Power of One 20


7/22 Get Moving – Junior Journey Playshop 21

7/23 Doggone that Training and First Aid! 21


7/26 Create-a-Fashion 22

7/28 My Buddy and Me: Get Moving – Junior Journey Playshop 22

7/28 Science is Everywhere! 22


7/29 Puzzles, Puzzles, Everywhere! 22

7/30 Horse Fan 18

CADETTEDate Title Page6/4 Balloon Twisting - Beginners 14



6/10 Lampworking 16

6/11 Discover Scuba 16



6/16 My Space 17


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6/18 Wheel Throwing 18






6/26 BeadDazzled 19





7/7 Kayak Basics 18




7/13 Flying High at Lockheed Martin 20







SENIORDate Title Page6/4 Balloon Twisting - Beginners 14

6/9 Car Clinic 15


6/10 Lampworking 16




6/16 My Space 17



6/22 Car Clinic 15






6/26 BeadDazzled 19




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7/7 Kayak Basics 18





7/14 Car Clinic 15



7/27 Car Clinic 15



AMBASSADORDate Title Page6/4 Balloon Twisting - Beginners 14

6/9 Car Clinic 15


6/10 Lampworking 16




6/16 My Space 17



6/22 Car Clinic 15






6/26 BeadDazzled 19




7/7 Kayak Basics 18





7/14 Car Clinic 15



7/27 Car Clinic 15



Day/ Twilight Camp

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Granbury Twilight Camp - Everything a Princess Needs to Know!Ever needed to know what poison ivy looks like or what to do if there is a tornado? Then come to Camp Granbury where as a princess in training you will learn what to do in emergency situations while doing fun princess activities. Also have fun with a royal sleepover on Thursday night! Granbury campgrounds are located on a ranch where girls will be doing activities in the main building which is open to the elements, as well as outside in grass covered terrain.Grade: All AgesDate: Monday, June 6 through Friday, June 10 Time: 4:00 – 8:00 p.m.Place: Reunion Court, 701 Reunion Court, Granbury, TX 76048Fee: $65Min/Max: 25/100Contact: Lori Smith at 817-776-1194

Pecan Grove Twilight Camp - Exploring AnimalsEver wanted to see wildlife up close? Surround yourself with animal friends while participating in songs, games and crafts with your human friends! Plus a family dinner on Friday, followed by an overnight for the girls! Pecan Groves campgrounds are located in front of the Masonic home, under a grove of pecan trees. Girls will be out in the elements throughout the duration of camp.Grade: All AgesDate: Monday, June 6 through Friday, June 10 Time: 5:30 – 9:30 p.m.Place: Masonic Home, 1501 West Division, Arlington, TX 76102Fee: $65Min/Max: 30/100Contact: Felicia Decker at 817-274-1237

Twilight Trails Twilight Camp - SurvivorCan you survive Camp Twilight Trails? Whether you’re young or old, during this fun-filled week, your “tribe” will be faced with outdoor challenges in games, crafts, songs, and archery. Outwit... Outplay... Outcamp! Twilight Trails campgrounds are located at Camp Burnett, where girls will be doing activities under the shade of trees or in the grass-covered meadow.Grade: All AgesDate: Monday, June 13 through Friday, June 17 Time: 4:00 – 8:30 p.m.Place: Camp Burnett, 3301 North White Chapel Road, Southlake, TX 76092Fee: $65Min/Max: 25/125Contact: Toni Adkins at 817-688-8076

Sunshine Meadows Twilight Camp - Blast to the Past!Sunshine Meadows this year will be going back in time! Experience what girls did for fun in the past. Challenge your campmate to a joust, maybe a fencing duel or a friendly competition in archery and, of course, have a blast at camp with crafts, games, cooking and everything in between!! On the last day of camp get ready for an overnight that will go down in history! Sunshine Meadows camp grounds are located behind a farming neighborhood. Activities will be held under the shade of trees or in the grass-covered meadow. Grade: All AgesDate: Monday, June 20 through Friday, June 24 Time: 5:00 – 9:00 p.m.Place: G. A. Walker Property, 160 Lace Lane, Burleson, TX 76028Fee: $65Min/Max: 20/200Contact: Debra Shackleford at 817-454-0226

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Wooded Acres Twilight Camp - Camp Wanahavalotafun!Looking for summer fun? Enjoy the beauty of Wooded Acres while hiking, singing camp song favorites, making friends, knot-tying, bird watching and making beautiful crafts and swaps. Try your hand at pitching tents and building a campfire with only two sticks! Come out and experience all the fun camp can offer! Wooded Acres campgrounds are located behind a small community center where girls will be under the shade of trees and on grass-covered terrain. Some activities may be held in the building.Grade: All AgesDate: Monday, June 27 through Thursday, June 30 Time: 5:00 – 9:00 p.m.Place: East Broad Presbyterian Community Center, 4517 East Broad Street, Mansfield, TX 76063Fee: $65Min/Max: 25/150Contact: Joyce Campbell at 682-222-7401

Wildlife Trails Day Camp - Swimming AwayJump in – the water is fine! Come to Wildlife Trails and enjoy a week of swimming and learning about nature in and out of the water. Have a blast with a camp cookout for all ages! Wildlife Trails campgrounds will be at the parks pavilion and in the grass field located adjacent to the pavilion. Girls will attend swim days at the pool located inside the park.Grade: All AgesDate: Monday, July 11 through Friday, July 15 Time: 8:30 a.m. – 3:30 p.m.Place: S. J. Stovall Park, 2800 West Sublet, Arlington, TX 76001Fee: $85Min/Max: 30/150Contact: Tracey McCullough at 682-564-4526

Middle initial:

City: State: Zip:

Phone:

Immunization History (must have dates):

Month/Year primary series completed: Month/Year last booster:

DTP

MMR

Polio

Date:

Camp fee: + $$12 membership fee (if not a member) + $ Check enclosed payable to GS-TOP: $

Cookie Bucks: _____ Boxes or $_____ - $ Charge my credit card this amount: $

Sister-to-sister transfer:

Financial Assistance Requested - $

Out-of-council Fee (if applicable) + $10

Registration: Staff Child or Program Aide FREE

Total Due $Office Use Only: Date Amt Type BalanceCamp: Date: Fee: P/W:

Girl Scouts of Texas Oklahoma Plains, Inc. DAY/TWILIGHT CAMP REGISTRATION FORM

GIRL INFORMATION

First name: Last name:

Address:

Custodial Parent/Legal Guardian signature:

I know of no reason, other than information indicated on this form, why my child should not participate in prescribed activities as noted. I give permission for my child to attend and participate in all activities related to this event. I understand some risk is inherent in a natural setting and in activities such as archery, horseback riding, swimming, canoeing and sailing. I understand safety equipment will be provided and agree that my child will be responsible for wearing protective equipment and following safety rules as instructed. I understand that there may be minimum skill requirements for some activities, and if my child does not meet them, she will not be allowed to participate in that activity. I will not allow her to attend the event if she becomes exposed to any contagious disease or if for any reason I do not consider her in good physical condition. Medications will be administered by or in the presence of the responsible adult and only with written permission from a legal guardian or physician. Medications should be in the original container, carefully labeled with the girl's name and dosage and must be accompanied with written instruction from a legal guardian or physician. In case of accident or illness, I authorize a representative of GS-TOP to give consent to a physician and/or hospital for medical and/or surgical treatment. It is understood that every effort will be made to notify me before such action is taken. I understand that GS-TOP may use photographs or audio/video of my daughter in event activities for publicity. I understand the Council cannot be responsible for loss of valuables. If not a currently registered Girl Scout, I give permission for her to join.

Birthdate:

Second parent/guardian name:

Address:

FEE INFORMATION

Form may be copied as needed. Please print clearly and use a pen with black or blue ink. Fill out entire form; incomplete forms will be returned and must be completed and resubmitted before a girl is placed. Mail or take the form with fee to your Regional Office or Service Center. If paying by credit card, you may fax the form; registrations will not be accepted by phone or email.

Primary Contact #:

School Grade in Fall 2011:

Custodial parent/guardian name:

Address (if different from above) :

Primary Contact #:

Exp. Date:

Cardholder’s signature:

Cardholder’s name:

Credit Card number:

Primary Contact #:

Emergency Contact:

Secondary Contact #:

Credit Card type: (circle one) VISA MC Discover Amex

METHOD OF PAYMENT Payment must be included with registration or it is incomplete.

__________________________________________________________

Are you registering a: Camper Staff Child Program Aide

PARENT/GUARDIAN INFORMATION

Who will pick your child up from camp? Drivers License #: State:

Sister's name Troop # # of Boxes


E-Mail Address (for confirmations):

Registered, Troop #: Juliette Not registered Out of Council? Council Name:

Hepatitis B:

Allergies: Check those that apply and list specific nature of reaction. Animals Pollen Medicine Plants Hay Fever

Insect Stings Food Other Describe reaction:

Girl Scout Level in Fall: Daisy Brownie Junior Cadette Senior Ambassador Non-GS

Varicella:

Camp name: Dates:

Name of Camp or Summer Extreme where you would like to volunteer:

Middle initial:

Gender: Male Female Birthdate:

City: State: Zip:

Day Phone:

Entering grade(s):

1. Place:

City: State: Zip:

2. Place:

City: State: Zip:

3. Place:

City: State: Zip:

Persons not related to you who can judge your qualifications for this position. If you have volunteer experience, one reference should be from them.

1. Name: Address: Phone:



Girl Scout Promise On my honor, I will try: To serve God and my country, To help people at all times, And to live by the Girl Scout Law.

Girl Scout Law I will do my best to be honest and fair, friendly and helpful, considerate and caring, courageous and strong, and responsible for what I say and do, and to respect myself and others, respect authority, use resources wisely, make the world a better place, and be a sister to every Girl Scout

Office Use Only: Appointment: (insert event name)

Date:

Girl Scouts of Texas Oklahoma Plains, Inc. SUMMER VOLUNTEER APPLICATION

VOLUNTEER INFORMATION


Address:

I would like to apply for: Day/Twilight Camp Volunteer Program Aide for Day/Twilight Camp Summer Extreme Volunteer

Social Security #:

Have you ever been convicted of, received deferred adjudication, or probation for a felony or misdemeanor? Yes No

Refusal based on:

Pending based on:

Referral based on: Signature of Authorized Council Personnel:

There shall be no discrimination in the recruitment, selection, learning opportunities, placement, retention and recognition of adult volunteers regardless of race, color, religion, sex disability, age or national origin.

Evening Phone: Cell Phone:

Are you a registered Girl Scout? Yes No If not, please include $12 membership fee with application.

Employed from:__________________ to ___________________

Address:

REFERENCES

Additional information: On another sheet, briefly list education, training, skills or other experiences that will enable you to carry out the responsibilities of the volunteer position you are seeking. Include experience in working with children, and your reason(s) for wanting to volunteer for GS-TOP.

I have read the Girl Scout Promise and Law and will allow them to guide my actions. I certify that all information provided on this application is true and complete and that I have not knowingly withheld any information, which might, if disclosed, affect my application unfavorably. I understand that any misrepresentation or omission of facts on this application may be considered justification for non-acceptance or dismissal if discovered at a later date. I give permission for my references to be checked. I understand that appointment to a volunteer position is contingent upon the completion and review of a criminal background check.

Signature: Date:

Email:

Email:

Email:

Phone:

Employee Volunteer

If yes, please state the offense, date and location:

Supervisor name:

If applying to be a Camp Program Aide, when did you complete the Basic PA course?

Employee Volunteer

List any special skills or hobbies you would like to share with participants:

Supervisor name:

Address:

Phone: Employed from:__________________ to ___________________

School(s):If adult, name of daughter(s):

Email: Drivers License #:

EXPERIENCE

Employee Volunteer

Supervisor name:

Address:

Phone: Employed from:__________________ to ___________________

Middle initial:

City: State: Zip:

Phone:

Check if parent/legal guardian would like to volunteer with activity.

Date:

Summer Extreme fee: + $

$12 membership fee (if not a member) + $

Cookie Bucks: _____ Boxes or $_____ - $

Sister-to-sister transfer: Sister's name:

Out-of-council fee (if applicable) + $10

Total Due $

Office Use Only: Date Amt Type Balance

Camp: Date:

Fee: P/W:

I know of no reason, other than information indicated on this form, why my child should not participate in prescribed activities as noted. I give permission for my child to attend and participate in all activities related to this event. I understand some risk is inherent in a natural setting and in activities such as archery, horseback riding, swimming, canoeing and sailing. I understand safety equipment will be provided and agree that my child will be responsible for wearing protective equipment and following safety rules as instructed. I understand that there may be minimum skill requirements for some activities, and if my child does not meet them, she will not be allowed to partcipate in that activity. I will not allow her to attend the event if she becomes exposed to any contagious disease or if for any reason I do not consider her in good physical condition. Medications will be administered by or in the presence of the responsible adult and only with written permission from a legal guardian or physician. Medications should be in the original container, carefully labeled with the girl's name and dosage and must be accompanied with written instruction from a legal guardian or physician. In case of accident or illness, I authorize a representative of GS-TOP to give consent to a physician and/or hospital for medical and/or surgical treatment. It is understood that every effort will be made to notify me before such action is taken. I understand that GS-TOP may use photographs or audio/video of my daughter in event activities for publicity. I understand the Council cannot be responsible for loss of valuables. If not a currently registered Girl Scout, I give permission for her to join.

Address:

Out of Council? Council Name:

FEE INFORMATION



CC #: Exp. Date:

Credit Card type: (circle one) VISA MC Discover Amex

Chronic and recurring illness: (check all that apply) Ear infection Asthma Seizures Diabetes Hypertension

Troop #: # of Boxes:

Specific transportation arrangements we should know about:

Custodial Parent/Legal Guardian signature:

Birthdate:

Second parent/guardian name:

Date of Event: Event Title:

Check enclosed (made to GS-TOP) Charge my credit card

Heart defect/disease Bleeding/clotting disorder Musculoskeletal disorder Other, specify:

Explain items that are checked: (indicate information useful to the adult in charge. Indicate activities to be restricted)

Other health conditions: (indicate any conditions which would impact her participation in this activity)

METHOD OF PAYMENT Payment must be included with registration or it is incomplete.

Registered, Troop #: Juliette Not registered

Emergency Contact:


Insect Stings Other Describe reaction:

HEALTH HISTORY


E-Mail Address (for confirmations):

Primary Contact #:

Custodial parent/guardian name:

Address (if different from above) :

Primary Contact #:

Girl Scouts of Texas Oklahoma Plains, Inc. SUMMER EXTREME GIRL REGISTRATION FORM

GIRL INFORMATION


Address:

Primary Contact #:

Form may be copied as needed. Please print clearly and use a pen with black or blue ink. Fill out entire form; incomplete forms will be returned and must be cmpleted and resubmitted before a girl is placed. Mail or take the form with fee to your Regional Office or Service Center. If paying by credit card, you may fax the form; registrations will not be accepted by phone or email.

School Grade in Fall 2011:

PARENT/GUARDIAN INFORMATION

Allergies: (check all that apply and list nature of reaction) Animals Pollen Medicine Plants Food Hay Fever

Birthdate: Sibling, grade in fall:

City: State: Zip:

Day Phone: Evening Phone:

Office Use Only:

$Receipt: Date:

Placed: Refunded:

Waiting List:

Birthdate: Sibling, grade in fall:

City: State: Zip:

Day Phone: Evening Phone:

Office Use Only:

$Receipt: Date:

Placed: Refunded:

Waiting List:

Address:

METHOD OF PAYMENT Adult/Sibling Summer Extreme Fee:

Check enclosed payable to GS-TOP:

Credit Card: (circle one) VISA MC Discover Amex

Credit Card number: Exp:

Email:

Emergency Contact: Primary Contact #:

Last name:

Address:

This form is to be used exclusively for Summer Extreme family events. This form my be copied as needed. Please print clearly and use blue or black ink. Fill out the entire form; incomplete forms will be returned and must be completed and resubmitted before a girl is placed. Attach this form to the Summer Extreme Girl Registration form and mail or take (with event fee) to your local Regional Office. Registrations will not be accepted by phone or email. A separate Adult/Sibling registration must be submitted for each person.

Girl Scouts of Texas Oklahoma Plains, Inc. SUMMER EXTREME ADULT/SIBLING REGISTRATION

INFORMATION

First name:

Address:

Last name:

Registering a: Boy Sibling Girl Sibling Adult




This form is to be used exclusively for Summer Extreme family events. This form my be copied as needed. Please print clearly and use blue or black ink. Fill out the entire form; incomplete forms will be returned and must be completed and resubmitted before a girl is placed. Attach this form to the Summer Extreme Girl Registration form and mail or take (with event fee) to your local Regional Office. Registrations will not be accepted by phone or email. A separate Adult/Sibling registration must be submitted for each person.

INFORMATIONRegistering a: Boy Sibling Girl Sibling Adult

First name:

Email:

Emergency Contact: Primary Contact #:


Girl Scouts of Texas Oklahoma Plains, Inc. SUMMER EXTREME ADULT/SIBLING REGISTRATION

METHOD OF PAYMENT

Credit Card number: Exp:

Adult/Sibling Summer Extreme Fee:

Check enclosed payable to GS-TOP:



Credit Card: (circle one) VISA MC Discover Amex

Address:

Summer Extreme

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Balloon Twisting - BeginnersCome learn about the types of balloons, pumps, and safety. Practice basic twisting techniques including inflation, tying, and locking twists with some basic essential creations! Note: Optional soft cover twisting book available at class for $5. Contact program provider (Melissa Lewis at 817-229-3555 or [email protected]) at least one week in advance to reserve book.Grade: Junior, Cadette, Senior, AmbassadorFee: $20Min/Max: 8/25

Date: Saturday, June 4 Time: 6:00 – 8:00 p.m.Place: Girl Scout Center, 4901 Briarhaven Road, Fort Worth, TX 76109

OR

Date: Friday, June 10 Time: 6:00 – 8:00 p.m.Place: Arlington Human Services Building, 401 West Sanford Street, Arlington, TX 76011

Balloon Twisting - IntermediateGirls will review and practice the basic techniques, plus adding the pinch twist. Class will cover intermediate level creations. Note: Students need to bring their pump from the Beginning class, or purchase their own. Optional soft cover twisting book available at class for $5. Contact program provider (Melissa Lewis at 817-229-3555 or [email protected]) at least one week in advance to reserve book. Grade: Junior, Cadette, Senior, AmbassadorFee: $17Min/Max: 8/25Note: Balloon Twisting - Beginners is a prerequisite for this class. Students need to be comfortable inflating and tying balloons and have practiced on their own.

Date: Friday, June 17 Time: 6:00 – 8:00 p.m.Place: Girl Scout Center, 4901 Briarhaven Road, Fort Worth, TX 76109

OR

Date: Friday, July 1Time: 6:00 – 8:00 p.m.Place: Arlington Human Services Building, 401 West Sanford Street, Arlington, TX 76011

Balloon Twisting - AdvancedGirls will review and practice the basic techniques, plus adding the pinch twist. Class will cover advanced level creations. Note: Students need to bring their pump from the Beginning class, or purchase their own. Optional soft cover twisting book available at class for $5. Contact program provider (Melissa Lewis at 817-229-3555 or [email protected]) at least one week in advance to reserve book. Grade: Junior, Cadette, Senior, AmbassadorFee: $17Min/Max: 8/25Note: Balloon Twisting - Intermediate is a prerequisite for this class. Students need to be comfortable inflating and tying balloons and have practiced on their own.

Date: Friday, July 8 Time: 6:00 – 8:00 p.m.Place: Girl Scout Center, 4901 Briarhaven Road, Fort Worth, TX 76109

OR

Date: Friday, July 29 Time: 6:00 – 8:00 p.m.Place: Arlington Human Services Building, 401 West Sanford Street, Arlington, TX 76011

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tsMaster of DisasterGirls will learn about the disaster cycle, and what they can do to prepare, respond and recover from disasters in their community, at school, and at home.Place: American Red Cross - Fort Worth, 1515 South Sylvania Avenue, Fort Worth, TX 76111Fee: $28Min/Max: 6/20

Grade: Daisy, BrownieDate: Saturday, June 4Time: 9:00 a.m. – 4:00 p.m.

OR

Grade: Daisy, BrownieDate: Saturday, July 23Time: 9:00 a.m. – 4:00 p.m.

OR

Grade: Junior, CadetteDate: Saturday, June 4 Time: 9:00 a.m. – 4:00 p.m.

OR

Grade: Junior, CadetteDate: Saturday, July 23 Time: 9:00 a.m. – 4:00 p.m. My Family and Me: FishingBring your favorite family members (at least one adult required, siblings are welcome), for a morning of family fishing! Whether you’re a novice or a pro, join us for some fun outdoors. Bring your own equipment or borrow some of ours (limited equipment available). Bait will be provided. Each girl attending must be accompanied by an adult. All adults must have a valid fishing license.Grade: All AgesFee: $15 per personMin/Max: 10/50

Date: Saturday, June 4 Time: 8:00 a.m. to noonPlace: Rough Creek Park, Lake Granbury, 193 Rough Creek Estate, Granbury, TX 76048

OR

Date: Saturday, June 18 Time: 8:00 a.m. to noonPlace: Bear Creek Park, 400 Bear Creek Parkway, Keller, TX 76248

Car ClinicDriving around town, all girls need to know the basics. Come to the car clinic to participate in checking engine fluids (oil, transmission, power steering), witness an oil and filter change, check tire pressure with a tire gauge, participate in changing a tire, learn about ABS vs. traditional driving, and what are emergency car kit essentials. Have the opportunity to interview a mechanic as well!Grade: Senior, AmbassadorPlace: Pepboys, 6500 Lake Worth Boulevard, Lake Worth, TX 76135Fee: $10Min/Max: 4/12

Date: Thursday, June 9Time: 6:00 – 7:30 p.m.

OR

Date: Wednesday, June 22 Time: 10:30 a.m. to noon

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Date: Thursday, July 14 Time: 6:00 – 7:30 p.m.

OR

Date: Wednesday, July 27 Time: 10:30 a.m. to noon

LampworkingLampworking is the art of making glass beads in a flame. Learn the essentials of heating a glass rod and wrapping it around a mandrel to form a bead, along with forming basic shapes and shop safety.Grade: Cadette, Senior, AmbassadorDate: Friday, June 10 Time: 6:30 – 8:30 p.m.Place: Brushstrokes Studio & Gallery, 4400 West Vickery Boulevard, Fort Worth, TX 76107Fee: $30Min/Max: 3/8

Child Safety ProgramGirls will learn about strangers, boundaries, distancing, verbal commands and physical self defense, all while having fun!Grade: Daisy, Brownie, JuniorPlace: The Gym, 921 West Mayfield Road, Suite 112, Arlington, TX 76015Fee: $15Min/Max: 8/20

Date: Saturday, June 11 Time: 10:00 – 11:00 a.m.

OR

Date: Saturday, July 9 Time: 10:00 a.m. – 11:00 a.m.

Discover ScubaDive into life and discover the exciting world of scuba! After orientation and getting to know the equipment, try out your new skills and go for a scuba dive in a pool.

Note: Program Provider reserves the right to exclude you from participation for certain health conditions at the time of the event. Refer to confirmation letter for more details. A special parental permission form is required and will be included in the confirmation letter.Grade: Cadette, Senior, AmbassadorPlace: Arlington Scuba, 2414 West Park Row Drive, Arlington, TX 76013Fee: $20Min/Max: 5/10

Date: Saturday, June 11 Time: 1:00 – 4:00 p.m.

OR

Date: Wednesday, June 22 Time: 6:00 – 9:00 p.m.

OR

Date: Wednesday, July 6 Time: 6:00 – 9:00 p.m.

OR

Date: Saturday, July 30 Time: 1:00 – 4:00 p.m.

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tsMy Buddy and Me: Candle MakingLearn the art of candle making and take home your own candle!Grade: Junior, Cadette, Senior, Ambassador, AdultsDate: Saturday, June 11 Time: 9:30 a.m. – 2:30 p.m.Place: Girl Scout Center, 4901 Briarhaven Road, Fort Worth, TX 76109Fee: $15 per personMin/Max: 10/20Note: A male or female adult must accompany girl.

My Buddy and Me: Klay KidsBasics don’t have to be boring. Boost your creativity learning the basics of clay handbuilding while making your very own clay project. Projects are left at the studio to be fired and can be picked up one week after event.Grade: Daisy, Brownie, Junior, AdultsDate: Sunday, June 12 Time: 4:30 p.m. – 6:00 p.m.Place: Brushstrokes Studio & Gallery, 4400 West Vickery Boulevard, Fort Worth, TX 76107Fee: $20 per personMin/Max: 8/20

My Buddy and Me: Graffiti CrewJoin the Abatement Crew and paint over graffiti. Meet at Graffiti Abatement office – participants will be transported to various sites by Graffiti Abatement staff to work on projects. At the end of the day, participants will be returned to the Graffiti Abatement office. Bring a sack lunch and drink, and plenty of water!Grade: Junior, Cadette, Senior, Ambassador, AdultsDate: Wednesday, June 15 Time: 8:00 a.m. – 2:30 p.m.Place: Graffiti Abatement Office, 920 Woodward Street, Fort Worth, TX 76107Fee: $7 per personMin/Max: 4/12

My SpaceThis is a creative workshop that combines ceramic painting and clay techniques for girls to design and create something fun for their room. Girls will choose from pencil holders, vases, or trinket boxes to paint and will create, build, shape, design, and paint a dry erase board out of clay. Items will be ready to pick up at the studio two weeks after the event. Glazing and firing fee included.Grade: Brownie, Junior, Cadette, Senior, AmbassadorDate: Thursday, June 16 Time: 6:00 – 8:00 p.m.Place: Sunshine Glaze Creative Studio, 405 North Carroll Avenue, Southlake, TX 76092Fee: $30Min/Max: 8/20

Pioneer SamplerWhat was life like for children in the 1800s? Find out as you learn how to weave, spin wool, wash clothes, grind corn, and go to school like a frontier Texan! Fee includes a craft and a Log Cabin Village patch.Grade: Brownie, JuniorPlace: Log Cabin Village, 2100 Log Cabin Village Lane, Fort Worth, TX 76109Fee: $15Min/Max: 8/25

Date: Friday, June 17 Time: 9:00 a.m. to noon

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Date: Friday, June 24 Time: 9:00 a.m. to noon

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Horse FanComplete parts of the Horse Fan badge requirements as you learn different riding styles, how to groom and care for a horse, how to saddle a horse, and learn horse safety. This event includes a brief arena ride, if time allows. A special parental permission form is required and will be included in the confirmation letter.Grade: JuniorPlace: Ride With Pride, 480 West Highland, Southlake, TX 76092Fee: $25Min/Max: 10/24

Date: Saturday, June 18 Time: 9:00 – 11:00 a.m.

OR

Date: Saturday, July 30 Time: 9:00 – 11:00 a.m.

Wheel ThrowingClay formed on a potter’s wheel is known as “throwing.” Participants will learn how to “center” their clay and open it to create the initial wall and base, along with experimenting with shapes. Projects are left at the studio to be fired and can be picked up one week after event.Grade: Cadette, Senior, AmbassadorDate: Saturday, June 18 Time: 6:30 – 8:30 p.m.Place: Brushstrokes Studio & Gallery, 4400 West Vickery Boulevard, Fort Worth, TX 76107Fee: $30Min/Max: 3/6

Kayak BasicsHave fun while learning the basics of kayaking through games and exercises designed to develop skills. All equipment is provided.Grade: Junior, Cadette, Senior, AmbassadorPlace: Marine Creek Lake, 4801 Marine Creek Pkwy, Fort Worth, TX 76179Fee: $40Min/Max: 4/8Note: Participants should be able to swim and feel comfortable around water.

Date: Thursday, June 23 Time: 9:00 a.m. to noon

OR

Date: Thursday, July 7Time: 9:00 a.m. to noon

Kayak TechniquesHave fun maneuvering strokes and tricks to control your kayak. Develop the necessary skills to be comfortable and confident on the water by understanding and practicing water safety. All equipment will be provided. Grade: Junior, Cadette, Senior, AmbassadorFee: $40Min/Max: 4/8Note: Should be able to swim and have taken Kayak Basics or have equal kayaking experience.

Date: Thursday, June 23 Time: 1:00 – 3:00 p.m.Place: Marine Creek Lake, 4801 Marine Creek Pkwy, Fort Worth, TX 76179

OR

Date: Thursday, July 7 Time: 1:00 – 3:00 p.m.Place: Pappy Elkins Lake, 3299 Elkins Drive, Dalworthington Gardens, TX 76016

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tsBabysitter TrainingLearn the knowledge and skills necessary to safely and responsibly give care for children and infants for any girl planning on babysitting. Girls will develop leadership skills, learn how to develop a babysitting business, keep themselves and others safe, help children behave, and learn about basic child care and basic first aid. Girls will receive their Babysitter's Certificate.Grade: Junior, Cadette, Senior, AmbassadorPlace: American Red Cross - Fort Worth, 1515 South Sylvania Avenue, Fort Worth, TX 76111Fee: $55Min/Max: 6/24Note: Must be entering 6th grade at the time of event to participate.

Date: Saturday, June 25 Time: 9:00 a.m. – 4:00 p.m.

OR

Date: Saturday, July 16 Time: 9:00 a.m. – 4:00 p.m.

Glass FusingLearn the essentials of fusing and slumping glass to create a tile or plate that is also decorated with colored glass “frit.” Projects are left at the studio to be fired and can be picked up one week after the event.Grade: Junior, Cadette, Senior, AmbassadorDate: Saturday, June 25 Time: 6:30 – 8:00 p.m.Place: Brushstrokes Studio & Gallery, 4400 West Vickery Boulevard, Fort Worth, TX 76107Fee: $25Min/Max: 3/15

My Buddy and Me: Badge of HonorThe National Cowgirl Museum and Hall of Fame is the only museum in the world dedicated to honoring women of the American West who have displayed extraordinary courage and pioneer spirit in their trailblazing efforts. Come see our rich history at the National Cowgirl Museum while working on a special National Cowgirl Museum patch.Grade: Daisy, BrownieDate: Saturday, June 25Time: 10:00 a.m. to noonPlace: National Cowgirl Museum and Hall of Fame, 1720 Gendy Street, Fort Worth, TX 76107Fee: $12.50 per personMin/Max: 10/30Note: An adult must accompany each registered girl.

Bead DazzledA course that is sure to catch your creative attention! Girls will enjoy making two pieces of jewelry for themselves or to give as a gift. Students will design and create their own bead bracelet and glass necklace. Girls will take home the bracelet the day of class; the glass pendant will be ready for pick up in two weeks after event. The glass firing fee for glass is included.Grade: Junior, Cadette, Senior, AmbassadorDate: Sunday, June 26 Time: 3:00 – 4:30 p.m.Place: Sunshine Glaze Creative Studio, 405 N Carroll Avenue, Southlake, TX 76092Fee: $30Min/Max: 8/15

My Buddy and Me: YogaHave fun with yoga! Stretches, breathing, games, partner poses, and relaxation help the body and mind to strengthen and recharge. You will also learn some tools which you can use in everyday situations to feel better and stronger. As yoga is deeply rooted in non-violence and respect for others, as well as oneself, it will help you to remain cool, calm, and collected even in challenging situations, such as bullying. Come try it out!Grade: Daisy, Brownie, Junior, Cadette, AdultsPlace: Grapevine Yoga, 213 West Wall Street, Grapevine, TX 76051Fee: $15 per personMin/Max: 8/12

Date: Sunday, June 26 Time: 2:00 – 3:30 p.m.

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Date: Sunday, July 17 Time: 2:00 – 3:30 p.m.

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Graffiti = Art or Vandalism?Learn about graffiti, how it differs from Art, and its impact on the community at large. Learn how graffiti can ruin future earning potential of the young individuals involved. Explore how to take action against graffiti.Grade: Junior, Cadette, Senior, AmbassadorDate: Wednesday, June 29 Time: 10:00 – 11:00 a.m.Place: Girl Scout Center, 4901 Briarhaven Road, Fort Worth, TX 76109Fee: $5Min/Max: 5/50

My Buddy and Me: Body MistLearn how to make your own body mist. Take a moment to make your own personal fragrance, choose from a variety of fragrances to create two scents of your preference and take these refreshing creations home.Grade: Junior, Cadette, Senior, Ambassador, AdultsDate: Saturday, July 9 Time: 9:30 a.m. – 2:30 p.m.Place: Girl Scout Center, 4901 Briarhaven Road, Fort Worth, TX 76109Fee: $15 per personMin/Max: 10/20Note: An adult must accompany each registered girl.

Flying High at Lockheed MartinWant to live life in the fast lane? Be involved in an automated wing-design program to develop a new wing which will allow an F-16 fighter jet to perform a new mission. Lunch with women engineers and hear about their careers. See what it’s like to fly high-performance aircraft through a tour of the state-of-the-art flight simulation lab. Grade: Cadette, Senior, AmbassadorDate: Wednesday, July 13Time: 9:00 a.m. – 3:00 p.m.Place: Lockheed Martin Aeronautics, Lockheed Boulevard, Fort Worth, TX 76116Fee: $15Min/Max: 12/24Note: Participatns must be at least ten years old and wear closed-toe shoes.

Power of OneSee how the power of one person can be an agent of change! Explore a piece of history at the National Cowgirl Museum while completing the Power of One component to the Agent of Change Journey series. Girls will complete the requirements to earn the Power of One Journey patch, and may participatein other events to earn the remaining components to complete the full patch. When completed the patch can be purchased from the Girl Scout Shops.Grade: JuniorDate: Saturday, July 16 Time: 10:00 a.m. to noonPlace: National Cowgirl Museum and Hall of Fame, 1720 Gendy Street, Fort Worth, TX 76107Fee: $15Min/Max: 10/30

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tsMy Buddy and Me: CeramicsSunshine Glaze enjoys hosting family outings. We believe that conversation and creative expression is a healthy combination for parents and their children. We will host this workshop for female adults and girls to come and each pick a ceramic item to paint together. Any ceramic items priced up to $20 in the store can be chosen. Firing and glazing fee is included and items will be ready to pick up in the studio in one week after event.Grade: All AgesDate: Sunday, July 17 Time: 3:00 – 5:00 p.m.Place: Sunshine Glaze Creative Studio, 405 N Carroll Avenue, Southlake, TX 76092Fee: $25 per personMin/Max: 8/24

My Buddy and Me: Me and My Shadow – Last chance to earn this retired badge!Experiment together with light, dark, color and shadow in this hands-on playshop. You will paint with light, create shadow puppets and take a light and shadow walk through the museum grounds. Girls will earn the Me and My Shadow Try-It.Grade: Brownie, AdultsDate: Thursday, July 21 Time: 10:00 a.m. to noonPlace: Fort Worth Museum of Science and History, 1600 Gendy Street, Fort Worth, TX 76107Fee: $15Min/Max: 15/36Note: Includes the Me and My Shadow Try-It.

Fanciful FlightsExploring and creating flying objects is the focus on this hands-on playshop. Super Loopers, balloon rockets and kites are just a few of the contraptions you will make. You will earn the Movers Try It.Grade: BrownieDate: Friday, July 22Time: 10:00 a.m. to noonPlace: Fort Worth Museum of Science and History, 1600 Gendy Street, Fort Worth, TX 76107Fee: $17Min/Max: 15/35Note: Includes the Movers Try-It.

Get Moving-Junior Journey PlayshopEnergy is inside us and all around us. During this playshop, you will learn about different types of energy, the energy in our places and spaces, and the energy of getting from here to there. You will complete some of the requirements for the Get Moving! Journey.Grade: JuniorDate: Friday, July 22 Time: 1:30 – 4:00 p.m.Place: Fort Worth Museum of Science and History, 1600 Gendy Street, Fort Worth, TX 76107Fee: $15Min/Max: 15/36

Doggone that Training and First Aid!Do you own a dog? Do you want to own a dog? Learn tips and techniques on how to train as well as first aid for your pet. Demonstration dogs will be on hand to show you how to work with your pet at home.Grade: JuniorDate: Saturday, July 23 Time: 9:00 – 11:00 a.m.Place: PetsWest, 102 Bear Cat Road, Aledo, TX 76008Fee: $15Min/Max: 6/15

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Create-a-FashionThis fashion forward class is for girls who like to create their own fashion. Each girl will enjoy designing and decorating their messenger bag with fabric, jewels, paint, and whatever they can imagine! We will also teach the students how to make their own wallet made of recycled products that will go great with their new messenger bag!Grade: Junior, Cadette, Senior, AmbassadorDate: Tuesday, July 26 Time: 6:30 – 8:00 p.m.Place: Sunshine Glaze Creative Studio, 405 N Carroll Avenue, Southlake, TX 76092Fee: $25Min/Max: 8/15

My Buddy and Me: Get Moving-Junior Journey PlayshopEnergy is inside us and all around us. During this playshop, you will learn about different types of energy, the energy in our places and spaces, and the energy of getting from here to there. You will complete some of the requirements for the Get Moving! Journey.Grade: Junior, AdultsDate: Thursday, July 28 Time: 1:30 – 4:00 p.m.Place: Fort Worth Museum of Science and History, 1600 Gendy Street, Fort Worth, TX 76107Fee: $20 per personMin/Max: 15/35Note: One male or female adult must accompany each girl.

Science is Everywhere! – Last chance to earn this retired badge!We know science is everywhere, but what better place than a science museum to discover, experiment, and create? We’ll investigate geologic forces of nature and animal habitats for an immersive playshop. Girls will earn the Science in Everyday Life badge.Grade: JuniorDate: Thursday, July 28 Time: 10:00 a.m. to noonPlace: Fort Worth Museum of Science and History, 1600 Gendy Street, Fort Worth, TX 76107Fee: $15Min/Max: 15/35Note: Includes the Science in Everyday Life Junior badge.

Puzzles, Puzzles, Everywhere!Love solving puzzles? Try your hand at some of the museum’s most interesting mathematics puzzles and make some of your own to take home and share with your family. Girls will earn the Puzzlers badge.Grade: JuniorDate: Friday, July 29 Time: 10:00 a.m. to noonPlace: Fort Worth Museum of Science and History, 1600 Gendy Street, Fort Worth, TX 76107Fee: $15Min/Max: 15/35Note: Includes the Puzzlers Junior badge.

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Girl Scouts of Texas Oklahoma Plains, Inc.

Instructions for Completing the Financial Assistance Application

All sections applicable to your request are required on the reverse side. This form may be completed by a parent/guardian, a Girl Scout volunteer (such as a troop leader, or service unit manager), or a council staff member.

No refunds for programs already attended will be granted.

The form can be mailed, e-mailed, or faxed to the regional office for the appropriate camp, along with $25 non-refundable deposit and the registration form, although in order for financial assistance information to remain confidential, mailing the application is preferred.

Please note: 1. Financial assistance is based on financial need and the application should reflect that need. 2. Financial assistance is limited; however, the council makes every effort to provide enough support so that

no Girl Scout in Texas Oklahoma Plains is denied participation due to lack of funds. If you have any questions, please call 817-737-7272 or 800-582-7272.

Instructions: Please be sure to check the girl or adult box to ensure appropriate processing of application.

Section I: This section is to be completed for all applications. In the instance of an adult applying for an adult learning opportunity there may be no troop number and those lines may be left blank. The grade level boxes can be checked for adult applicants, indicating the grade level of girls you volunteer with. The service unit name should be filled in. Juliette Girl Scout parents can use zeros for the troop number, write “Juliette” for troop leader and use the name of their nearest school if they do not know their Service Unit.

Section II: Household income helps determine the need for financial assistance.

Section III: This section is used when requesting uniform components and program materials. If request is granted, a voucher will be mailed to you to be used to obtain items from a council shop.

Section IV: This section is used when requesting assistance to attend a council event. Assistance granted will be applied to the event fee. Amount granted will be included in the confirmation notice.

Section V: This section is used when adults are requesting assistance to attend an adult learning opportunity offered by the council.

Notification of assistance will be e-mailed or mailed within two weeks of receipt of application.

National Membership Dues: To request assistance for these dues, use the form entitled “Request for Girl Scout National Membership Dues.”

A gift to the Girl Scouts of Texas Oklahoma Plains Annual Campaign ensures financial assistance is available for every girl or adult who needs help to participate in Girl Scouting.

Girl Scouts of Texas Oklahoma Plains, Inc.

Financial Assistance Application Do not use this form to request assistance for National Membership Dues. Please use blue or black ink pen. This form may be photocopied.

To maintain confidentiality, put application in an envelope and mark it: Confidential; Attention: Financial Assistance, as instructed in “F”.

NOTE In order to remove financial barriers to participation in Girl Scouts, limited funds are available to cover some expenses. Requests are reviewed on an individual basis. Financial assistance cannot be granted for troop activities. Troops are expected to budget for troop activities, outings, and other needs in their

troop treasuries. This financial assistance request DOES NOT register the applicant for any event/learning opportunity. This request must be attached to the

appropriate event/learning opportunity registration form. The council does not reimburse funds already spent.

How to apply for financial assistance A. All CURRENTLY registered girl and adult members are eligible to receive financial assistance. B. A parent, troop leader or other adult may make a request. C. Use one application per recipient. D. Allow two weeks to process. E. Refer to the Financial Assistance Guidelines on the reverse side of this form for more information. F. Complete form and mail along with the Resident Camp Registration form and $25 non-refundable deposit to the Regional Office for the appropriate camp.

I. Personal Information

Applicant’s name: ______________________________________________

� Girl or � Adult Troop # _____________

� Check if non-troop affiliated Service Unit: _____________________

Address: ____________________________________________________

City: __________________________ State: ___________ Zip: __________

Grade Level: � Daisy � Brownie � Junior � Cadette

� Senior � Ambassador � Adult-Position: ________________

� New Member � Returning Member Years in Girl Scouting:_______

Participated in most recent council product sale: � Yes � No

Amount of Cookie Bucks earned: $ __________

Name of Person completing application: ________________________

Position: __________________ Address: _________________________

City: __________________________ State: __________ Zip: __________

Phone: _____________________ Email: __________________________

Requestor’s signature: ________________________ Date: __________

II. Estimated Household Income � Under $15,000 � $15, 000 - $25, 000

� $25 ,000 - $35,000 � $35,000 – 45,000

� $45, 000 - $55, 000 � $55,000 or more

Number of individuals supported by this income: ______

Number of dependents living at home: ______

Has any financial assistance been granted this year? � No � Yes

If yes, please state amount $ ___________________________

Why is financial assistance needed? ___________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

III. Uniform Components, Insignia and Printed Materials

Materials needed: ________________________________________________________

Total Cost: $_____________

IV. Program Fees for council-sponsored events, day camp, or resident camp. Assistance will be granted to cover a partial or full amount of the event fee. Attach event registration form.

Event Name: __________________________________ Event Date: _____________

Event Fee: $ ____________ Amount Requested: $ _______________________

For Resident or Day Camp – Camp Name:____________________________________

V. Adult Learning Opportunities Includes council-sponsored learning opportunities. Attach learning opportunities registration form.

Course Name: ___________________________________ Course Date: __________

Course Fee: $___________ Amount Requested: $ ______________________

FOR OFFICE USE ONLY

Date received:____/_____/______

Amount approved: $__________

Date approved: ____/____/_____

Notes:

Non-Profit OrganizationU.S. Postage

PAIDPermit No. 2277Fort Worth, TX

4901 Briarhaven Rd, Fort Worth, TX 76109817-737-7272 • 800-582-7272 www.gs-top.org

Girl Scouting builds girls of courage, confidence, and character who make the world a better place.

2011 GS-TOP Day/Twilight-Summer Extreme Guide

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