Light Up The Season - Girl Registration Form

Girl Scouts of Northern New Jersey

For girls in Kindergarten or First Grade who are attending our 'Light Up The Season' event. Please submit one registration form per girl. This is for girls who are new to Girl Scouts.
This event includes all event activities and your girl's membership (valid through September 30, 2026). Memberships are renewable annually on or before October 1st each year.

This membership is provided through generous support from a community partner. To meet the requirements to receive this funding, all information on this form must be disclosed.

Welcome to Girl Scouts!

We look forward to seeing you soon.
Which location are you attending?*

Roxbury Senior Center, Succasunna - Monday Dec 15 (6:30-8:30pm)American Legion, Lincoln Park - Wednesday Dec 17 (6-8pm)
Will you be staying or dropping off? If you are dropping off, you will need to complete a permission form. We will email this to you once you have registered.*

I'm stayingI'm dropping off
Girl Name*

First NameLast Name
Birthday*
(mm/dd/yyyy)
Grade for the 2025/2026 School year*
School Name*
Girl's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
She is (check all that apply):*

WhiteAmerican Indian/Alaskan NativeAsianBlack/African AmericanHawaiian or Pacific IslanderOther
Girl is Hispanic or Latina:*

YesNo
Caregiver Name*

First NameLast Name
Caregiver address if different from Girl's:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Caregiver Birthday*
(mm/dd/yyyy)
I am the Primary Caregiver/Contact (as listed above)*

YesNo
Caregiver Race (check all that apply):*

WhiteAmerican Indian/Alaskan NativeAsianBlack/African AmericanHawaiian or Pacific IslanderOther
By opting in for emails and text alerts, you agree to receive important information concerning membership, programs, cancellations, and closures as applicable. Understanding such content is not required to join. I wish to opt in for:*

TextsEmailsNeither
Caregiver E-mail*
example@example.com
Caregiver Mobile/Cell Number*
In order to accommodate girls of all abilities, please indicate if your child has any disabilities as defined by the Americans with Disabilities Act:*

YesNo
If yes, what accommodations does your child need:
The Girl Scout Promise: On my honor, I will try: To serve God and my country, to help people at all times, and to live by the Girl Scout Law. (When making the Girl Scout Promise, individual members may substitue wording appropriate to their own spiritual beliefs for the word "God".)

The Girl Scout Law: I will do my best to be honest and fair, friendly and helpful, considerate and caring, courageous and strong, and responsible for what I say and do, and to respect myself and others, respect authority, use resources wisely, make the world a better place and be a sister to every Girl Scout.
I accept and abide by the Girl Scout Promise and Law:*

YesNo
When participating in Girl Scout activities, I (or the person I am registering) give consent to be interviewed, photographed, videotaped, or electronically imaged for purposes of promotional materials, news releases, or other published formats for either the local Girl Scout Council or Girl Scouts of the USA. The images will be the sole property of the local Girl Scout Council or Girl Scouts of the USA. I hereby release and hold harmless the local Girl Scout Council and Girl Scouts of the USA from any claim arising from the use of these images. I accept the Media Permission:*

YesNo
Caregiver/Contact Signature and CC Authorization. This signature serves as permission for the registrant to join Girl Scouts.*

Clear
Signature Date*

MonthDayYear
Date
Should be Empty:

Girl Scouts of Northern New Jersey