AMT Adult Volunteer Registration Form
Adult Volunteer Registration Form
Personal Information
First Name:*
Last Name:*
Primary Role*
Secondary Role*
Date of Birth:*
Gender:*
Pronoun*
Ethnicity*
Race*
Phone:*
Type
Home Cell Work Other 
Alt Phone:
Type
Home Cell Work Other 
E-Mail:*Valid e-mail is required
Address Line 1:*
Address Line 2:
City:*
State:*
Zip Code:*
T-Shirt Size:*
My Camp Nickname:
Troop Number(s) (if leader)
I have volunteered at camp before*
Yes No 
Registered Girl Scout?*
Yes No 
If you aren`t already registered with Girl Scouts of America, it`s your responsibility to register BEFORE camp begins. On the thank you page for this form, we will provide links for registering.
I understand that I must register as a Girl Scout before camp
I will volunteer all week
(Children of full-week volunteers are guaranteed a place in camp)
OR
I will volunteer on the following days (check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Assignment Preference
1st Choice*
2nd Choice*
Adult Volunteer Registration Form
Name(s) and grade(s) in Fall of this year (age if Pre-K) of my children attending camp
To give each camper the opportunity for their own special camp experience, camp practice is to place volunteers in units without their children. However, if you must work in your child`s unit, please specify the reason. Partial week volunteers will be placed where there is the greatest need and cannot be guaranteed placement with their child.
I must be placed with my child`s unit
Yes No 
Reason:
Must be completed by all volunteers
Personal Information
Emergency Contact Name:*
Emergency Contact Phone:*
Type
Home Cell Work Other 
Emergency Contact Alt. Phone:
Health History & OTC Medications
Family Medical/Hospital Insurance Carrier
Policy or Group #
Health History Record (Check all that apply)
Chronic or recurring illnesses:
Heart Defect / Disease
Seizures
Bleeding / Clotting
Asthma
Diabetes
Other (if checked, specify below)
Any restrictions concerning physical activities?
Choose One*
PLEASE ENTER YES OR NO
Please describe any conditions:
Allergies: (If checked, specify in the space below each)
Food, Nuts
List all food/nut allergies
Food Allergy Severity (some/all foods listed))
Severe - Any exposure requires immediate medical attention
Other - Give details below
Food Allergy Notes (details for each food)
Insect Stings
Medicine / Drugs
Other
Special dietary restrictions?
Tetnus?*
Date of last booster? (year)
Please list any medications taken on a daily basis, including over-thecounter medications:
Any other relevant health concerns:
Volunteer Permission and Release
I understand and agree to cooperate with all camp and Girl Scout regulations. I will not attend camp if I am not in good physical condition. In an emergency, I give permission for the camp authorities to take any emergency measure deemed appropriate. My emergency contact will be notified as soon as possible.

I certify that the health history provided above is complete and accurate. I am able to engage in all prescribed activities, except as noted above.

By typing my name below and clicking the `I AGREE` button, I acknowledge that I fully understand and agree to all provisions of this Permission and Release and that this action is equivalent to signing a printed copy of the Permission and Release.
I AGREE*Must click to complete reg.
Name:*Provide complete name
I wish to opt out of media permission at this time.
I wish to opt out of GSUSA/GSOSW emails/texts at this time.
Reset 
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