16-17 GSCTX Camp Reservation Form
Type of Retreat:
☐ Troop
☐ Service Unit
☐ Non-GS Group
Main Contact:
Name:
Troop #:
Address:
City:
Phone #:
SU #:
State:
Zip:
Email:
Camp Facility Options
Camp:
☐ Camp Kachina
Begin Date (mm/dd/yy):
End Date: (mm/dd/yy):
Unit/Lodge Total Cost (A): $
Unit/Lodge:
# of
Participants
☐ Zilker Cabin (No Activities/Meals)
☐ Camp Texlake
Daisy:
Brownie:
Junior:
Cadette:
Senior:
Ambassador:
Non-GS:
Total:
GS Adult Females:
GS Adult Males:
Non-GS Adults:
Total:
Activity/Meal Options
Available for
ALL
Available for
ONLY
Girls/Boys
☐ Camp Activities Pass ($15 per) #________
☐ Meal Pass ($30 per) #________
☐ Horse Tales Package ($30 per) #________
☐ Let’s Trail Ride Package ($30 per) ________
☐ Grooming & More Package ($30 per) #________
☐ High Ropes Package ($30 per) #________
Activity Total Cost (B): $
Meal Total Cost (C): $
Cancellation Policy
If a camp reservation is to be cancelled, the Main Contact must inform the Camp Registrar by email 60 days in advance of their
campout weekend of their cancellation request in order to receive all paid funds back. If the cancellation is received after the 60
day deadline date, the Camp Reservation Deposit will be held.
In submitting this form I agree that if permission is granted for this activity, the policies and guidelines of Girl Scouts of the USA
and Girl Scouts of Central Texas will be followed. I agree that the activity will meet the Girl Scout educational expectations and
have read the policies for this activity in Volunteer Essentials and the GSCTX Policies and Procedures.
☐ Let’s Go 1 ☐ Let’s Go 2
☐ Let’s Go 3
“Let’s Go”
Trained Adult: (GS only)
Level:
CPR/First Aid
Trained Adult: (GS Only)
Date of
Certification:
Unit/Lodge Total Cost: (A) $
Payment Method: ☐ Cash
☐ VISA
☐ Mastercard
☐ Check #_________
☐ Discover
☐ Am Ex
Card #:
Exp Date:
Signature:
CVV:
Billing Zip:
Activity Total Cost:
(B) $
Meal Total Cost:
(C) $
Security Deposit of $50 per
unit required)
Total Amount:
$
$
Questions about reservations, please submit a ticket to [email protected]
Send Camp Reservation Form To:[email protected] or
Mail to Girl Scouts of Central Texas, 12012 Park Thirty-Five Cir, Austin, TX 78753
GSCTX
2/9/2016