SUMMER FUN APPLICATION

ADULT VOLUNTEERS
(Only registered Girl Scout volunteers who have submitted a background check will be considered.)

PLEASE PRINT
Name and location of camp: Science Back Date of camp: June 13, 14, 15, 2011

Your name_____________________________________________________________________

Child(ren)’s names ______________________________________________________________

Your home address Troop # __________

Home phone ______________ Work phone ________________ Cell phone ________________

Email address __________________________________________________________________

Are you a registered Girl Scout volunteer? ___ yes ___ no

Indicate grade level you wish to work with: Daisy ___ Brownie___ Junior/Cadette ___
-OR-
Indicate activity where you wish to work

nurse/first aid ___ crafts ___ food ___ outdoor ___ songs ___ other (list) _____________

Please list any special accommodations that might be necessary for you to perform the job for
which you are applying ___________________________________________________________

Please list adult Girl Scout experience, including current position(s) ________________________

______________________________________________________________________________

In case of emergency, indicate someone local who should be notified and could pick you up

Name ______________________ Phone(s) __________________________________________

Are you a nurse? ___ yes ___ no

Are you certified in first aid and/or CPR? ___ yes ___ no

If yes, indicate level/course: first aid __________________ Expiration date ________________

CPR _____________________ Expiration date _______________

I give my permission for Girl Scouts of Greater South Texas Council to verify all information I have
provided. I affirm the information above is true and correct.

Signature ________________________________________ Date ________________________