Fall 2019 Inspire Discovery

Individual Activity Application (continued) Minor Photo Release For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I hereby consent and agree to the following:

1. I hereby grant to Girl Scouts of the USA (“GSUSA”) / Girl Scouts of Eastern Missouri (“GSEM”), and others working for GSUSA / GSEM or on its behalf, and each of its respective licensees, successors and assigns (each a “Releasee”), the irrevocable, royalty-free, perpetual, unlimited right and permission to use, distribute, publish, exhibit, digitize, broadcast, display, modify, create derivative works of, reproduce or otherwise exploit my name, picture, likeness and voice (including any video footage of the same), testimonials (written by me or attributed to me), interviews (written by me or attributed to me) (collectively, “Media”), or to refrain from so doing, anywhere in the world, by any persons or entities deemed appropriate by GSUSA / GSEM, for any purpose including, without limitation, any use for educational, advertising, non-commercial or commercial purposes in any manner or media whatsoever (whether known or hereafter devised) including, without limitation, on the Internet, in print campaigns, in-store and via television. I agree that I have no interest or ownership in any of the Media. 2. I shall have no right of approval, no claim to compensation and no claim (including, without limitation, claims based upon invasion of privacy, defamation or right of publicity) arising out of any use, alteration, blurring, illusionary effect or use in any composite form of my name, picture, likeness and voice. I agree that nothing in this Release will create any obligation on GSUSA / GSEM to make any use of the Media or the rights granted in this Release. I hereby release and hold harmless Releasees from any claim for injury, compensation or negligence resulting or arising from any activities authorized by this Release and any use of the Media by GSUSA / GSEM.

� I wish to opt out at this time.

Signature of Parent/Guardian — ———————————————————————————————————————————————————————————

Parent/Guardian Name (please print) — ——————————————————————————————————————————————————————

Aerial Silks , pg. 52 � Cadette � Senior/Ambassador APO Badge Workshop , pg. 59 Girl Scout Brownies � Inventor Badge � Bugs Badge � Painting Badge Girl Scout Juniors � Product Designer Badge � Flowers Badge � Social Butterfly Badge Girl Scout Cadettes � Cosmic Artist Badge � Eating for You Badge � Animal Helpers Badge Archery Tournament , pg. 21

Become a Star-Volunteer with Metro Theater Co. - It's a Wonderful Life , pg. 46 � Dec. 6 � Dec. 7 � Dec. 13 � Dec. 14 Become a Star-Volunteer with Metro Theater Co. - Ghost , pg. 54 � Feb. 16 � Feb. 21 � Feb. 23 � Feb. 28 Cadette Club , pgs. 38, 44, 55 � Entire Series � Oct. 17   � Nov. 21 � Feb. 20

Fall Equestrian Adventures , pg. 20 � Pony Tales � Hoofprints

Market Adventures , pg. 49 � 10 am-12:30 pm � 1-3:30 pm

Playing the Past , pg. 45 � 9 am-noon � 1-4 pm Reach for the Stars Astronomy Club � The Solar System, Nov. 6, pg. 42 � The Moon, Jan. 15, pg. 49 � The Sun, March 11, pg. 57 Self Defense (C,S,A) , pg. 47 � 11 am-noon � 1:30-2:30 pm   Self Defense (J) , pg. 47 � 12:15-1:15 pm � 2:45-3:45 pm � 4-5 pm Spring Break Days , pg. 58 � Skate and Swim � Journey Through Art and History � Under the Sea

� Extended Trail � Saddle Scout � Troop Ride and Cookout � Rider � Non-Rider

Dates in order of preference: —————————————————————— Girl Scouts Go , pg. 15 Choose your race: � 5K � 1-mile T-shirt size: � Youth Small  � Youth Medium  � Youth Large � Adult Small  � Adult Medium  � Adult Large  � Adult XL � Adult XXL  � Beanie Girl Scout Night at Hidden Valley , pgs. 52 and 56 � Jan. 31 � Feb. 28  Gold Award Candidate Training , pg. 31 List the date and location: —————————————————————— Will an adult be accompanying you? List his or her name: —————————————————————— Junior Jewelers , pg. 43 � 9 am-noon � 12:30-3:30 pm

Camp Keepers Service Day , pg. 22 � Camp Tuckaho

� Camp Cedarledge � Camp Fiddlecreek Cutting Edge , pg. 39 � Beginner � Intermediate Extreme Team , pgs. 18-19 � Entire series � Adventure 1, Oct. 26 � Adventure 2, Nov. 16 � Adventure 3, Jan. 17-19 � Adventure 4, Feb. 22 � Adventure 5, March 28 � Adventure 6, April 4-5 � Adventure 7, May 22-24

� Sept. 15 � Oct. 20 � Nov. 10 � March 22 � April 19 � May 3

� Spring Break Before Care � Spring Break After Care Taking Charge of Your Troop pgs. 41 and 51 � Nov. 3 � Jan. 26

Badge Day Craft Alliance , pg. 44 � 9-11 am � noon-2 pm  � 3-5 pm � Clay � Metal � Technology � Wood � Textiles

66 Inspire Discovery Fall 2019