Spring 2020 Inspire Discovery

Individual Activity Application

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 — ———————————————————————————————————————

Registrant Name — —————————————————————————————

Address ———————————————————————————————————

City — ——————————————————— State — ———— ZIP — ——————

Primary Phone — ——————————— Cell Phone — ———————————

Email — ————————————————————————————————————

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

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

Current Grade — ——————————————————————————————

Troop # — ——————————————————————————————————————

District/Neighborhood ———————————————————————————

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)

� 2020 Empowerment Project � 314 Day � Agent of Change Journey Day � aMUSE! Journey Night � Aerial Silks � Back to School Palooza � Bee Care � Beyond the Stars � Boundary Waters Canoe Adventure � Bow and Arrow Club � Brownie Safety and First Aid � Brownie Snooze at the Zoo � Cadette Camp-A-Rama � Cadette Camp-A-Rama Volunteers � Cadette Club � Cadette Cybersecurity Badge Day � City Nature Challenge � Community Clean Up � Daisy Journey � Dance Workshop � Engineering Adventures � Environmental Stewardship � Flower Power Palooza � G.I.R.L. Convention � Camp Open House � Camp Out Palooza

� Girl Scout Junior Road Trip to Louisville � Girl Scout Matinee with Metro Theater Co. – Ghost � Girl Scout Night at The Muny - Mary Poppins � Girl Scout Night at The Muny - The Sound of Music � Girl Scouts Love State Parks � Gold Award Boot Camp � Gold Award Candidate Training � Household Elf � It’s a Small World-Brownie Journey � Jetting to Jefferson City � Junior Cybersecurity Basics � Junior Safety and First Aid � Junior Snooze at the Zoo � K-City Bound! � Kansas City Roller Trip

� Multi-Level Think Like a Programmer Journey � My Best Self � Older Girl Environmental Stewardship

� Spring Equestrian Adventures � STEM Badge Extravaganza � Sun Day on a Sunday � Super Hero Palooza � Supportive Sunny � Think Like a Citizen Scientist - Prairie Exploration � Think Like an Engineer Day Camp � Think Like an Engineer Brownie Journey � Think Like an Programmer Journey � This to That � Trail Explorer Day Trip � Upcycle for Animals � We Salute You with Gerri � What Robots Do � Wonderful World of Plants

� Olympic Palooza � Organic Farming

� Outdoor Journey Weekend � Pack the Creek Saturday and Sunday � Paddle Boarding � Planetarium Show � Playing the Past � Reach for the Stars Astronomy Club - Journey to Mars � Ready, Set, Improv � Rifle Exploration � Robotics Showcase � SA Cupcake Wars � Science of Chocolate � Science of Ice Cream � Science of Sound � Shaw Park Nature Reserve Overnight � Soar Into STEM with Wings of Hope � Shotgun Exploration � Splash Into Summer Palooza � Spring Break Days

� Leap Day Clean Up � Leap Year Palooza � Legacy Artist Badge � Let’s Make a Deal

� Luck of the Irish Palooza � May the Fourth Palooza � Mechanical Engineering Badge Workshop � Mighty Mississippi Overnight Adventure

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girlscoutsem.org Inspire Discovery Spring 2020

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