BizSmARTS Application

Des Moines, August 3-8, 2009

There is a fee of $175 per student for the week long camp. The fee helps cover costs that include instruction, class materials, snacks, lunches and the graduation reception.

If you have any questions or would like more information, please contact Holly Eggleston at heggleston@gsiowa.org or 800-342-8389.

Please complete the following:
First Name
Last Name
Birthdate	MM/DD/YYYY
School
School City
Parent/Guardian
Home Address
City	State Zip
Home Phone
Student is under custodial care of (Select one) Both parents Mother only Father only Other
Parent/Guardian Cell Phone
Parent/Guardian Email
Emergency Contact
Contact's Relationship to Girl
Contact Phone
Contact Cell Phone
Grade you are completing
Age
Gender	F M
Racial/Ethnic Background	American Indian or Alaskan Native Asian Hispanic/Latina Black or African American Hawaiian or Pacific Islander White/Caucasian Other
If you are a current Girl Scout, please enter your troop number
Are you an Invent Iowa participant?	Yes No
Student
Please tell us why you would like to attend our camp. Include descriptions of your artistic and/or entrepreneurial activities, interests and ambitions! Please list any allergies, injuries, or health conditions Please list any medications currently being used
Parent or Guardian Consent
I recommend for participation in the Entrepreneurship in the Arts Summer Day Camp to be held in Des Moines, IA and I agree to attend the formal graduation ceremony upon my child's completion of the program. I, as the parent/legal guardian of authorize my child to participate in all phases of the Girl Scouts of Greater Iowa's program. I hereby consent to register my daughter for the Girl Scout Program. The registration will expire on September 30, 2010. In case of injury or illness, I give my permission for my daughter to be seen by the first aider and/or a qualified physician if deemed necessary. Where immediate care is necessary, the Girl Scouts of Greater Iowa staff has permission to seek medical attention. I hereby consent and agree that any photo/video taken of my daughter by Girl Scouts of Greater Iowa become property of said Council. Photos/videos may be used for any legitimate publicity/promotion without compensation.
Parent/Guardian Name	Date
Parent/Guardian Name	Date