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Please complete all required fields below (* required)

*Last Name *First Name Middle
*House Number *Street
*City *State *Zip
*Primary Phone: xxx-xxx-xxxx Secondary Phone: xxx-xxx-xxxx
*Email Address: *Service Unit:
*School closest to home: *School District:
Best time to call: Morning   Afternoon   Evening
*I would prefer to be contacted by: Email   Phone call
I am interested in volunteering in the following pathways. Please check all that apply:
Direct Service-Working with girls in one of the pathways:

CAMP: Unplug from your everyday demands and explore the great outdoors with a group of like-minded girls. Share your passion and unique talents with tomorrow's outdoor enthusiasts.

EVENTS: Have high energy but limited availability? Choose your favorite topics, and help girls unleash their potential. During half- to three-day events, you'll interact with girls, excite their passions, and help them become their best selves.

SERIES: Have a particular skill or talent? Looking for a chance to work with girls without a long-term commitment? Then come share your passion with a focused group of girls who can't wait to learn your skill or pursue your area of interest.

TRAVEL: Expand girls' horizons. Explore the world-or at least your corner of it-with a group of girls who need your help planning a trip, earning money, and preparing themselves for the adventures of travel.

TROOPS: Want to participate in exciting activities, throughout the school year, with a small group of girls? You'll share so much as the girls in your troop earn awards and badges, go on field trips, and learn from community leaders and experts on issues important to your community.

VIRTUAL: Coming soon! Enjoy mentoring girls in an online environment. The magic of the Internet will link you with girls who immerse themselves in leadership activities, earn badges, and enjoy the virtual-but very real-friendships that blossom.

Indirect Service-Working with other adults to insure that girls have meaningful opportunities:

Fundraising/Special Events
Planning Committee
Product Program
Teaching or Mentoring

How often can you be involved?

Once a week Once a month Quarterly Other

* List three persons (non-relatives and not residing in the same household) who are familiar with your qualifications for Girl Scout service.

Name Relationship Address Day Phone Evening Phone Email Address

*Have you ever been convicted of a crime (e.g., felony or misdemeanor including DWI, DUI, etc., but not including minor traffic violations or any convictions as a youthful offender)? A conviction will not necessarily bar your acceptance as a volunteer.
Yes No

This is an application for a volunteer position in Girl Scouting for which there is no monetary compensation.

In the selection of volunteers, there shall be no discrimination against an otherwise qualified individual on the basis of race, color, ethnicity, sex, religion, creed, national origin, socioeconomic status, age, disability, marital status, veteran status, or any other basis prohibited by federal, state, or local law.

I hereby authorize you to check all my educational, personal, and employment references; I further authorize these references to release to you information that they have about me.

I authorize Girl Scouts of Ohio’s Heartland, to conduct a criminal records check at their discretion and agree that, if requested, I will fully cooperate in providing all information and signing all documents necessary to conduct such a check.

Appointment to certain volunteer positions is subject to a satisfactory criminal background check.

I understand that any misrepresentation, omission, or falsification of any fact from this application or during any interview will be cause for rejection of this application or dismissal from volunteer services. I also understand that acceptance for volunteer services are subject to verification of references.

I certify that my answers to the preceding questions are true and complete and that I have not knowingly withheld any information which might, if disclosed, have a negative effect on my application.

I hereby authorize the Girl Scouts to perform all reasonable and necessary background investigations regarding my application to be an active volunteer for the Girl Scouts. I also authorize the Girl Scouts to inform necessary persons of any limitations in my ability to volunteer identified by such background investigation, including but not limited to applicable adult leaders. I hereby release and hold harmless the Girl Scouts and any volunteers regarding any conduct or disclosure resulting from any investigation which I have authorized herein.

By typing my name on this form, I am entering my “electronic signature” (as that term is defined in the Uniform Electronic Transactions Act, RC 1306.01, et seq) and certifying that I have read, fully understand and accept all terms of this registration

Please type your name

Upon submitting your information, you will be taken to the Background Check form.


© 2012 Girl Scouts of Ohio's Heartland · 1700 WaterMark Drive · Columbus Ohio 43215-1097 · 1-614-487-8101 · 1-800-621-7042