Facilitated Outdoor Program Request Form

General Contact Information

Welcome!

We hope you are as excited about your potential facilitated outdoor program as we are. We ask that to help us get started in planning your program, to please answer the questions below. You will hear from a member of our Outdoor Program Team within 10 business days of submitting your interest regarding program availability. We cannot place programs with less than 30 days notice.

Please note that completion of this request form is not a guarantee that we will be able to facilitate an outdoor program for your troop/group.

Here is a list of possible available WEEKEND dates for a facilitated outdoor program through the end of 2023. 2024 weekend dates coming soon.

Most weekdays are available if requesting a weekday facilitated program.

Camp Butternut Springs:

-September 29-October 1

-October 13-15

-October 20-22

-October 27-29

-November 3

-November 5

-November 11-12

-November 17-19

-December 15-17

Camp Greene Wood:

-September 22-23

-October 13-15

-October 27-29

-November 3

-November 5

-November 11-12

-November 17-19

-December 15-17

Camp Juniper Knoll:

-September 22-23

-September 29-Octiber 1

-October 27-29

-November 3

-November 5

-November 11-12

-November 17-19

-December 15-17

Camp Palos:

-September 22-23

-October 6-8

-October 14-15

-October 20

-October 22

-November 3-5

-November 17-19

-December 15-17

Please double check this information for accuracy, as this is what we will use to contact you moving forward.

First Name *

Last Name *

Group's Name *

Group's Troop or Service Unit Number

Group's City *

Group's State *

Zip Code *

Email Address *

Primary Phone Number *

Secondary Phone Number *

Will there be a secondary contact for this group? *

Yes

No

Secondary Contact Information

Secondary First Name *

Secondary Last Name *

Secondary group's name if different from primary *

Secondary Primary Phone Number *

Secondary Phone Number *

Secondary Email Address *

Program Size

Please note we have a minimum of 12 participants, including children and adults, for all custom programs.

How many girls do you think you will have attending? *

What are the age groups of your girls?
(check all that apply) *

What Grade(s) will your group be at time of your requested program? (For programs occurring before June 1, 2023 it is the grade the girl is in for the 2022-2023 school year. For programs after June 1, it is the grade she is in for 2023-2024 school year.) *

How many adults do you think you will have attending? *

Will siblings or other non-Girl Scout children be invited to your event? *

Yes

No

How many other children do you think you will have attending? *

If your group falls short of the minimum of 12 participants (children and adults), are you willing to combine your program with another troop? *

Yes

No

Kindergarten	First Grade	Second Grade	Third Grade
Fourth Grade	Fifth Grade	Sixth Grade	Seventh Grade
Eight Grade	Ninth Grade	Tenth Grade	Eleventh Grade
Twelfth Grade Twelfth Grade