Lakeview Service Unit Registration Form 2005-2006

Complete and return to Heather Stevens 435 Deer Run Drive  Central Square, NY 13036

Troop # ______________  Age Level ______________

Leaders Name _______________________________ Day Phone ________

Address ____________________________________ Eve Phone _________

City/State ____________________________________  Zip ____________

Email _______________________________________

Emergency Contact _____________________________________________

Any special needs YES  Or NO

  If yes, explain ________________________________________________

Please register our troop for:

Program Name _________________________________________________

Program Date ________________________ Place ____________________

Number of                                                        Fee                                          Total

__________ Girl Scouts                  @$ ___________                        =_________

__________ Adults                        @$ ___________               = _________

                                                            Total Amount enclosed: ___________

Payment Info:

Please include all necessary fees.    If paying by check, make out to Lakeview SU. 

___________ cash                        _________ Check #___________

Please list all Girls/adults attending program:

Girl Scouts:                                                                               Adults

__________________________________                ______________________________ __________________________________                ______________________________

__________________________________                ______________________________

__________________________________                ______________________________

__________________________________                Girl Scouts:

__________________________________                ______________________________

__________________________________                ______________________________

__________________________________                ______________________________

__________________________________                ______________________________

__________________________________                ______________________________

__________________________________                ______________________________