Girl Member Reg Waiver Form
Girl Member Reg Waiver Form
Girl Member Reg Waiver Form
girl
REGISTRATION FORM
Program Year 2013 2014
"I promise to love God, cherish my family, honor my country, and serve in my community." PLEASE PRINT LEGIBLY, COMPLETE FULLY AND DO NOT ABBREVIATE ____ New Girl ____ Returning Girl ____ Transfer from Troop # _______________
GIRLS LAST NAME _________________________________ FIRST NAME _________________________________ NICKNAME ____________________________________________________ SCHOOL (Check one) _____PUBLIC ______PRIVATE BIRTHDATE ______/______/______ GRADE: ______________
_____HOME SCHOOLED
LEVEL: Pathfinder (5-6 yrs. & in K) Tenderheart (6-9 yrs./grades 1,2 or 3) Explorer (9-12 yrs./grades 4,5 or 6) Pioneer (12-14 yrs./grades 7 or 8) Patriot (14-18 yrs./grades 9, 10, 11 or 12)
(The minimum age requirement for each level must be met by Oct. 31 .)
st
African American Alaska Native Asian Caucasian/White Hispanic/Latino Native American Pacific Islander Other FAMILY INFORMATION: All mailings from AHG will go to this name and address.
FAMILYS LAST NAME _____________________________________ HOME PHONE # (______) _______________
MAILING ADDRESS_______________________________________________________________________________ CITY ________________________________________________________ STATE __________ ZIP ______________ STREET ADDRESS (if different) _______________________________________________________________________ FAMILY EMAIL ADDRESS __________________________________________________________________________
(This email address will be used for communication from AHG, Inc.)
PARENT/GUARDIAN INFORMATION:
RELATIONSHIP _______________ (mother/grandmother, etc.) FIRST NAME____________________________________ LAST NAME____________________________________ EMPLOYER_____________________________________ OCCUPATION___________________________________ WORK E-MAIL:__________________________________ WORK # (_______) _______________________________ CELL PHONE # (______) __________________________
PARENT/GUARDIAN INFORMATION:
RELATIONSHIP _______________ (father/grandfather, etc.) FIRST NAME__________________________________ LAST NAME___________________________________ EMPLOYER___________________________________ OCCUPATION_________________________________ WORK E-MAIL:________________________________ WORK # (_______) _____________________________ CELL PHONE # (______) ________________________
IMPORTANT: PLEASE COMPLETE CONSENT, WAIVER AND RELEASE AGREEMENT ON BACK. INCLUDE THE NON-REFUNDABLE REGISTRATION FEE. REGISTRATIONS MUST BE RECEIVED AT THE AHG OFFICE BEFORE A GIRL MAY PARTICIPATE IN ANY MEETING OR EVENT. Registration fees are non-refundable. Membership is transferable to another Troop
Registration Fee:
$26.00
Cash
Check
(OVER)
_____________________________________________________
Participants Name (PRINT)
Troop #: _______________________________
State Code and 4-Digit #
_____________________________________________________
Parent/Guardian Signature
______/______/______
Date
Cincinnati, OH
45246
513.771.2025
2/11
1/13