Girl Membership Form

Tell Us About You and Your Girl!

Girl Scout membership is available to all girls in grades K to 12. Pre-K girls are eligible to join beginning April 1st of the calendar year they will enter kindergarten. Girl Scout membership is good through 9/30/2026.
Already a member? Renew here.
Caregiver Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Were you a Girl Scout? Daisy, Brownie, or higher - it all counts.

YesNo
Caregiver Ethnicity*
Caregiver Race (Check all that apply.)*

American Indian or Alaskan NativeAsianBlack or African AmericanHawaiian or Pacific IslanderWhiteOther RacesI choose not to share.Staff Only - Family did not report race.
Caregiver's Gender*
Caregiver's Birth Date*

MonthDayYear
Date
Phone Number*
No mobile information will be shared with third parties/affiliates for marketing/promotional purposes.
E-mail*
example@example.com
Caregiver's Relationship to Girl*
Girl's Grade - What is your girl's grade for the 24-25 school year?*
Girls entering Kindergarten in Fall 2025 are eligible to join Girl Scouts starting April 1st. Would you like us to register your girl then or would you like to wait until fall.*

Register my girl on April 1st! She's so excited!!We're still deciding, please send me more information.
Girls that are not entering Kindergarten in 2025 are not yet eligible. Would you like to be contacted when your girl is eligible?*

Yes, she'll start kindergarten in Fall 2026.No, we'll reconsider on our own.
Girl's Full Name*

First NameLast Name
Girl's Ethnicity*
Girl's Race (Check all that apply.)*

American Indian or Alaskan NativeAsianBlack or African AmericanHawaiian or Pacific IslanderWhiteOther RacesI choose not to share.Staff Only - Family did not report race.
Girl's Birth Date*

MonthDayYear
Date
Girl's School Attending - What school does your girl attend? If in Pre-K, what school will she attend for Kindergarten?*
Enter School's Name Ex. Juliette Lowe Elementary
Girl's School Attending for Kindergarten*
Enter School's Name Example: Juliette Lowe Elementary
What size t-shirt does you girl wear?*
Troop Desired - Please list the troop number, troop leader's name, or a girl's name that you want to be in a troop with, if known. Don't have any of this information, just let us know what you're looking for: close to home, at school, church, etc.
Does your girl have Medicaid? In Kentucky, Wellcare and United Healthcare will cover her Girl Scout membership.*
Financial Assistance

Girl Scouts of Kentuckiana is dedicated to removing barriers and providing access to Girl Scout membership, and all financial assistance provided is made possible by our generous donors.
If the membership fee of $63 is out of reach, we want to help. Would you like to explore Financial Assistance?

No. I will join with the $63 fee.Yes. Show options for a reduced membership fee.
WHY: Financial circumstances shouldn’t prevent membership in Girl Scouts of Kentuckiana. Our local council can help lower your cost for the membership fee.

WHAT: We can help cover the membership fee through our generous donors. You pay what you’re able, and the remaining cost is supplemented by local donors who believe that every Girl Scout will benefit from a strong sense of self, develop positive values, seek challenges, build healthy relationships, and solve community problems.

HOW: We want to welcome your Girl Scout! If you need, consider the private options below. To supplement the $63 membership fee, select the option below which describes your ability to pay. Your membership fee will be adjusted before you pay. We depend on the trust and honesty of our members as we use limited funds to offset these membership fees.
Option

I'm able to pay 75% - or $47.25 - toward membership, and council donors cover the rest.I'm able to pay 50% - or $31.50 - toward membership, and council donors cover the rest.I'm not able to pay toward Girl Scout membership, and 100% of the membership fee will be covered by donors.
Membership Fee Calculation
Credit Card Payment: This form prompts you to pay via PayPal when you click submit. PayPal will open in a new window. You may pay with a credit card, a PayPal account is not required.
Girl Scout Membership Fee Through 9/30/2026

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USDDescription
By completing membership registration, I affirm that I understand and agree to adhere to Girl Scout Child Abuse Prevention policies and procedures.
Name of Person Submitting Form*
Should be Empty:

Tell Us About You and Your Girl!

Financial Assistance