Girl Scouts of Eastern Pennsylvania

Girl Membership Interest Form
We're glad you are interested in joining Girl Scouts! Please complete this form and click on the submit button at the bottom of this form. Please note that girls will be placed in troops near their own neighborhoods or schools depending upon the availability of volunteer leadership. Placement is handled in local areas by our volunteers. A volunteer or staff Membership Manager will contact you once your girl is placed.

Please indicate if you are interested in:
Troop Placement	As an Individual

Tell us about you:
Girl's First Name	Girl's Middle Name	Girl's Last Name
Date of Birth	Grade	Name of School Attending
Neighborhood Public Elementary School
School District Name		County
Parent/Guard First Name	Parent/Guard Middle Name	Parent/Guard Last Name
Mailing Address
City	State	Zipcode
Daytime Telephone	Evening Telephone
Email Address
Best Time to Reach Parent/Guardian
Tell Us How You Heard About Girl Scouts
Friend	Web	Brochure
Yard Sign	Bus Ad	Flyer
Subway Ad	Other:

Please Check All That Apply
We have re-located from another Girl Scout Council.		Name of Council
My girl is currently in a Girl Scout Troop and would like to be transferred to another troop.		Current Troop Number

Reason For Transfer Request

If You Are Interested in Helping With Your Girl's Troop, Please Select From the Following
Lead or Co-Lead
Assist a Leader
I would like to help with troop activities

Comments or Questions

If you are interested in volunteering as an adult, please read and sign the agreement below:

I understand that I will need to become a registered member of Girl Scouting ($12 fee) and that a background check will be done using my Date of Birth and Social Security Number. This information will be kept confidential. After submitting this form, I understand a staff Membership Manager or Volunteer Service Team Member will be in contact with me. Please enter your name in the box below for agreement: