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Online Girl Interest Form

I want my daughter to be a Girl Scout! This interest form is for girls who attend school within Santa Clara County and would like to become a Girl Scout. This is NOT a registration form, and we will use the following information to place your daughter into a troop. If a troop is not available for your daughter, she may register independently for Girl Scout program as part of our "virtual" troop. If you have already submitted this form within the last month, please do NOT resubmit. If you have not been contacted within 5 working days, please call (408) 287-4170 x411.

	Girl Name
	Parent or Guardian First Name
	Parent or Guardian Last Name
	Address including City
	Zip Code
	School Name
	Grade
	Home Phone
	Alternate Phone
	Email Address
	Are you interested in being a leader or co-leader?

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