Girl Scout Request Form


	Girl Scout Request Form

Please use this form to indicate your preferred Girl Scout workshop date(s) and topic. Once we have received your request, we will send you a confirmation letter via email.

CUSTOMER INFORMATION

Troop #:

Troop Leader Name:

Home Address:

CONTACT INFORMATION

It is important that we are able to contact you if we have any questions. Your email address will be used to send you a confirmation letter.

Day Phone:

Cell Phone:

Email:

WORKSHOP DATE(S)

1st Choice:

2nd Choice:

WORKSHOP TOPIC

WORKSHOP INFORMATION

Start Time:

# of Girls:

Ages:

Select One: Brownie Scout Junior Scout

Location where workshop will be held:

Please provide the name of the location and the address.

Directions:

Please provide directions from the nearest freeways.

Special Instructions:

PAYMENT INFORMATION

The fee for the workshop is $10.50 per girl with a minimum payment for 15 girls. A travel fee will also apply.
You will receive an invoice for the workshop two weeks in advance. Mail payment for this program one week in advance to Mad Science.

This form is to request a Girl Scout workshop. Clicking on the submit button will transfer your workshop request to
Mad Science of San Diego

Please do not submit this form for an inquiry only.
Send your inquiries to mail@madsciencesd.com.