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Girl Scout Interest Form

This interest form is for girls who live within the Girl Scouts of the Pioneer Council jurisdiction (Cleveland, Gaston, Lincoln, Polk and Rutherford counties) and would like to become a Girl Scout.

Please note this is not a registration form. We will use this information to try to place your daughter into a troop. If a troop is not available for your daughter, she may register as an individual (non-troop affiliated) and participate in council sponsored program opportunities.

Note: Information marked with a red asterik (*) are required to process this form.

Girl's Information
Name: *
School: *
Grade: *
Age: *
Prefer troop near: Home     School
Prefer troop to meet:
Sun Mon Tue Wed Thu Fri Sat
Afternoon
Evening
Parent/Guardian's Information
Name: *
E-mail Address: *
Address 1: *
Address 2:
City: *
State: *
Zip Code: *
Day Phone:
Evening Phone: *
Cell Phone:
Was this girl in a troop last year?
The success of the Girl Scout program depends on enthusiastic, dedicated, adult volunteers. Please select one or more areas where you can help:
Troop Leadership (assistant leader, co-leader, leader)
Helping at troop meetings
Other:
If there are any questions you have or special requirements, please let us now here:
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