Pick Up Form

Pick Up Form

Please list the person, or possible persons, who will be picking up your daughter from the specified Girl Scout activity. Event staff will be referencing this list during check out procedures. Adults will be required to show ID.
Pick Up Person 1*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relationship to girl*
Pick Up Person 2

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Relationship to girl
1st Activity Name*
1st Activity Start Date

MonthDayYear
1st Activity Location (City)
2nd Activity Name
2nd Activity Start Date

MonthDayYear
2nd Activity Location (City)
3rd Activity Name
3rd ActivityStart Date

MonthDayYear
3rd Activity Location (City)
The person(s) listed above have my permission to pick up my daughter from the Girl Scout activity(ies)
Girl Scout Participant Name*

First NameLast Name
Your Name*

First NameLast Name
Signature*
Should be Empty: