AMT Adult Volunteer Registration Form
Adult Volunteer Registration Form
Personal Information
First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
Zip Code:*
Home Cell Work Other 
Alt Phone:
Home Cell Work Other 
Alt Phone:
Home Cell Work Other 
E-Mail:*Valid e-mail is required
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)
I will volunteer on the following days (check all that apply)
Assignment Preference
1st Choice*
2nd Choice*
When selecting buses, please select your first choice. Adjustments may need to be made depending on demand, please be flexible.

If `No Bus` is chosen, you may not have the option of adding it later. Please choose carefully as changes must be approved by camper directors via email.
Bus Option*
Adult Volunteer Registration Form
Name(s) and grade(s) in Fall of 2019 (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 
Must be completed by all volunteers
Personal Information
Emergency Contact Name:*
Emergency Contact Phone:*
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
Bleeding / Clotting
Other (if checked, specify below)
Any restrictions concerning physical activities?
Choose One*
Please describe any conditions:
Allergies: (If checked, specify in the space below each)
Food, Nuts
Insect Stings
Medicine / Drugs
Special dietary restrictions?
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.
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