Fall 2019 Inspire Discovery

Individual Activity Application Registrant Name — —————————————————————————————

Disability Information: Girl Scouts of Eastern Missouri welcomes the participation of all girls and adults and will make reasonable accommodations for persons with disabilities. If you have questions or if you want to discuss an accommodation, please contact the Answer Center at 314.400.4600 or answercenter@girlscoutsem.org. Does your child need a reasonable accommodation?  � Yes � No Describe: — ————————————————————————————————————— Method of Payment — all monies received are cashed or charged when received by Girl Scouts of Eastern Missouri. Check all that apply: � Check or Money Order  � Debit Card  � Visa   � MasterCard   � Discover A) Program Fee Amount $ — ———————————————————————— B) Charitable Gift Enclosed $ — —————————————————————— C) Total Fee (A+B) $ ————————————————————————————— Credit Card Information Account # — ————————————————— Exp. Date — ——————— Cardholder's Signature — —————————————————————————— Date — ———————————————————————————————————————

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Parent/Guardian Email ———————————————————————————

Current Program Level (circle) D B J C S A Adult

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Racial Ethnic Background (optional)

The following information is requested only to measure progress toward serving all girls in our jurisdiction.

� White � Black � Asian � Hawaiian/Pacific Islander  � Hispanic � American Indian/Alaskan Native � Other

Dietary Requirements: ———————————————————————————

I am applying for: (Check only one)

� 3 14 Day � Active with Nature � Aerial Silks

� Daisy Mechanical Engineering Badge Workshop

� It’s Show Time! � Junior Coding for Good � Junior First Aid and Safety at Mercy � Junior Jewelers � Junior Safety and First Aid � Kids4Pets

� Sewing for Good � Senior Journey Mission: Sisterhood � Shaw Park Nature Reserve Overnight � Smart Cookie � Social Innovator � Spa Night � Special Agent Badge Workshop � Spoil Older Scouts Weekend � Spooky Science � Spring Break Days � Staying Fit Badge Program � STEM Badge Workshop at Wash U � Supermoon Viewing Party � Take Over with Tula � Taking Charge of Your Troop � Tennis Extravaganza � Think Like an Engineer Journey Day

� Daisy Palooza � Daisy Safety � Eating for You � Edward Jones Cookie College � Extreme Team � Fall Equestrian Adventures

� APO Badge Workshop � Archery Tournament � Badge Day at Craft Alliance � Ballet Workshop � Beautiful You � Become and Star and Volunteer with Metro Theater Co – It’s a Wonderful Life � Become and Star and Volunteer with Metro Theater Co – Ghost � Boo-tastic Palooza � Brownie Coding for Good � Brownie Cybersecurity Basics � Brownie Mechanical Engineering Badge Workshop � Brownie Safety and First Aid � Cadette Chopped Challenge � Cadette Cupcake Wars � Cadette Cybersecurity Basics � Cadette Club � Cadette MEdia Journey: Parts 1 and 2 � Cadette Program Aide Workshop � Cadette Trivia Night � Camp Keeper Service Days

� Leap Year Palooza � Leap Day Clean Up � Luck of the Irish Palooza � Mail Call to Action � Making Coin in Canton � Market Adventures � Metal Tooling

� Fall for Flowers � Feed Me Money

� Field Day Badge Program � First Responders Palooza � Fly Like An Eagle � Galentines

� Mud Balling � My Best Self � My Best Selfie � My Family Story � Navigating College Life � New Year, New Me – Fit Fab Fun � Northern Cupcake Wars � Peter and the Wolf at the St. Louis Symphony � Plain White T’s Palooza � Playing the Past � Practice with Purpose Badge Program � Reach for the Stars Astronomy Club � Restore Our Habitats � Riflery Exploration � Rockin' Racquetball � Roller Derby Crash Course-Beginner � Roller Derby Crash Course-Intermediate � SA Cupcake Wars

� Gateway to Geospatial Technology � Geminids Meteor Shower Overnight � Get Savvy with the Federal Reserve � Girl Scout Game Jam � Girl Scout Go: Run for the Cookies � Girl Scout Junior Road Trip to Louisville � Girl Scout Matinée with Metro Theater Co – It’s a Wonderful Life � Girl Scout Matinée with Metro Theater Co – Ghost � Girl Scout Night at Hidden Valley � Girl Talk: Be Your Own Kind of Beautiful � Giving Back � Gold Award Boot Camp � Gold Award Candidate Training � Great Garden Party Journey � High School Chopped Challenge � Highest Awards Open House � I.O.U. � Insider Insight

� Travel Open House � Tremendous Trees � Ugly Doll Palooza � Up for Snow Good Palooza � Volunteer-in-Training � What’s My Value? � Winter GAM � Winter Splash

� Charitable Sewing � Cosmic Climbing � Crazy Corn Maze � Cutting Edge

� Cybersecurity Safeguards for Brownies � Cybersecurity Safeguards for Daisies � Daisy Coding for Good � Daisy Diner

� Safari Palooza � Self Defense

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