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Benton Day Camp 2026 Registration Form

July 13 - 17, 2026
87Questions
  • 1

    A fully completed, signed registration packet must include the following:

    1. Completed Benton Day Camp Registration
    2. Signed Behavior Contract
    3. Completed Health History & OTC Meds Form -- either online or downloaded and mailed in to Registrar.
    4. Full Camp Payment
    5. PA Application (if applicable) -- either online or downloaded and mailed in to Registrar. Due by Sunday, May 11.

     

    A completed registration packet does not guarantee camper placement. For registration questions, please contact registrar@bentondaycamp.org. DO NOT mail Benton Day Camp registrations to the Girl Scout service center in Portland or Eugene.

    Note:  Only one camper may be registered at a time.

    Note: You MUST complete a Health Form or your registration is incomplete!

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  • 2

    If you want to review your entire Registration Form without having to click back through every page or screen, click on the bottom of the screen where it says the page number of 87 (e.g., 2 of 87). All of the questions will appear, and you can select which page (or dot) you want.

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    You MUST complete the Health History & OTC Medications Form for your registration to be complete. Please fill it out now online by clicking the link below.  After completion, you should be directed back to the beginning of this Registration Form.

    Online version of the Health History & OTC Medications Form

     

    If you want to download and mail the Health History & OTC Medications Form via US Postal Service, go to the Downloads page on our Benton Day Camp website after completing this Registration Form.

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    Every camper must have a completed Health History & OTC Meds Form before stepping onto the bus or into camp. You may complete and submit either

    • the online version of the Health History & OTC Medications Form

    • by downloading, completing and mailing it to the Registrar:

    Elsie Sandin
    Registrar, Benton GS Day Camp
    7540 NW Hood View Circle
    Corvallis, OR  97330


    Remember:  A camper's registration is not complete (nor is her spot saved) until the Registrar receives her completed Health History & OTC Medications Form.

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    Acceptance and participation in summer programs is the same for everyone without regard to race, color or national origin. As an equal opportunity organization, Girl Scouts is dedicated to diversity and fully supports the right of equal access for girl and adult members with disabilities. Girl Scouts of Oregon and Southwest Washington makes every reasonable effort to ensure this access. We encourage you to voluntarily provide the following information on racial back-ground and ethnicity. This information will be used by Girl Scouts of the USA for statistical purposes only and to help improve outreach efforts and advance the Girl Scout Movement.

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  • 10
    Please check one
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  • 11
    Please check as many as apply
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    who lives with camper / same address
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    Parent/Guardian #1
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    Parent/Guardian #1
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    Parent/Guardian #1
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    Parent/Guardian #1 who lives with camper -- Same address.
    Please Select
    • Please Select
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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    • 1st grade
    • 2nd grade
    • 3rd grade
    • 4th grade
    • 5th grade
    • 6th grade
    • 7th grade
    • 8th grade
    • 9th grade
    • 10th grade
    • 11th grade
    • 12th grade
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    Grade next Fall
    • Daisy (Grade 1)
    • Brownie (Grade 2-3)
    • Junior (Grade 4-5)
    • Cadette (Grade 6-8)
    • Senior, Ambassador (Grade 9-12)
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  • 23
    Day Camp is for girls who want to make new friends, learn new skills and have lots of fun. Girls will be in units with girls from many troops or girls new to Girl Scouting. This is not a troop camp experience. Members of a troop will most likely not all be in the same unit. We will make our best attempt to place girls with their buddy, however this cannot be guarenteed.
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  • 24
    Full-time is volunteering for 20 hours or more before or during Benton Day Camp 2026
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    (if applicable)
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  • 27
    PAIT = Program Aide In Training. NOTE: If girl has already completed the PAIT program, select NO. Girls in Grades 7-9 not applying for the PAIT or PA program will automatically be in the Adventurers Unit.
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  • 28
    Must also complete & submit a PA Application and ALL associated forms by Sunday, May 11. Girls are not required to move to the next PA level. Girls applying for PA1 must have completed PAIT Training or the equivalent.
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    Parent/Guardian #2
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    Parent/Guardian #2
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    Parent/Guardian #2
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    Other than Parent/Guardian #1 or #2
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    Emergency Contact
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    Emergency Contact
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    authorized to pick up your camper in addition to parent/guardian. All must show photo identification.
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    of Name 1 authorized to pick up your camper
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    authorized to pick up your camper in addition to parent/guardian. All must show photo identification.
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    of Name 2 authorized to pick up your camper
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    authorized to pick up your camper in addition to parent/guardian. All must show photo identification.
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    of Name 3 authorized to pick up your camper
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    Camper's Name
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    include medications or other information pertinent to the Health Supervisor
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  • 46
    Parent/Guardian Signature
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    Parent/Guardian Signature
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  • 48
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  • 49

    The Overnight Permission Slip Form must be received by Day Camp staff by Tuesday, 7/14.  Complete it now above online, or download, complete and give to your camper's Unit Leader by Tuesday of Day Camp week.

    An Overnight Packing List is available on the Benton Day Camp website plus one will be included with the Confirmation Letter.

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  • 50
    • Youth Small
    • Youth Medium
    • Youth Large
    • Adult Small
    • Adult Medium
    • Adult Large
    • Adult XL
    • Adult XXL
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  • 51

    Optional Hooded Sweatshirt

    We have a cool optional sturdy Benton Day Camp hooded sweatshirt with our original logo for campers, staff and all volunteers for $35.00. Stay warm and show your love for our Benton Day Camp all year round!

    To order our new camp hoodie, go to the Benton Day Camp Hooded Sweatshirt Order Form.

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  • 52
    Please select one of the following:
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  • 53

    Parent / Guardian Permission for Day Camp

    As a legal guardian I give permission for the registrant to participate in all phases of camp activities and off-site trips. I understand that it is my responsibility to inform the day camp of activities that my camper may not participate in. I understand and agree to cooperate with all regulations. I will not allow registrant to attend if not in good physical condition. In an emergency, when the undersigned or other person named cannot be reached, I give permission for the camp authorities to take any emergency measure deemed appropriate. It is understood that all reasonable efforts will be made to contact the parent/guardian.


    I understand that when participating in Girl Scout activities the registrant may be photographed for print, video or electronic imaging. I understand that the images may be used in promotional and fund raising materials, news releases and other published formats, and will be the sole property of Girl Scouts of Oregon and South-west Washington, its assigns or successors, or Girl Scouts of the USA.

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    Electronic Signature
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    for Electronic Signature
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  • 60

    Behavior Agreement for Day Camp

    Day camp is a unique and exciting opportunity for girls to have fun, improve skills, make new friends, experience the outdoors, and learn from positive adult role models! To be successful at day camp, it's important to remember the Girl Scout Promise and to live by the Girl Scout Law. Parent/Guardian AND camper --Please read carefully before signing. All campers and parents/guardians are asked to sign the Behavior Agreement for Day Camp individually.

     

    GIRL SCOUT LAW

    I will do my best to be

    ... honest and fair

    • I agree to follow all camp rules
    • I agree to tell the truth at all times while I'm at camp.

     

    ... friendly and helpful

    • I agree to get to know other campers by learning their names and understanding that their personalities and backgrounds may be different from my own.

     

     ... considerate and caring

    • I agree to participate fully in the camp experience by leaving my phone and all electronics at home. I understand that if I break this agreement and bring these items, Girl Scouts of Oregon and SW Washington is not responsible for these items.
    • I agree to treat others with respect, even if they are different from me.
    • I understand that my behavior affects others in my group and I will do my best to be a positive group member.

    ... courageous and strong

    • I agree to let an adult know about any behavior I see that may be hurtful or harmful to myself or others (examples: bullying, threats, name-calling, leaving the group without permission, etc).
    • I agree to use my words, take deep breaths and think before acting if i become upset.

    ... responsible for what I say and do

    • I agree to use appropriate language and behavior. Fighting, behavior and words that could hurt myself or others is unacceptable.
    • I agree not to bring alcohol, tobacco, controlled substances, illegal drugs, firearms or weapons to camp.
    • I agree to take an active part in learning and having fun at camp.

     

    and to

    ... respect myself and others

    • I agree to respect other campers' and volunteers' belongings and space.
    • I will ask and receive permission before using other campers' things.
    • I also agree to keep my hands to myself.
    • If I am having a problem with someone or something, I agree to respectfully talk to that person and/or a volunteer.
    • I agree to respect wildlife and nature and not cause harm to them. 

    ... respect authority

    • I agree to respect adults volunteering at camp and to follow their directions.
    • I agree to remain with my unit at all times unless I have permission from my unit leader to be somewhere else.
    • I agree to use the buddy system the entire time I'm at camp.

    ... use resources wisely

    • I agree to be kind to animals, nature and buildings at camp, and to not cause any harm to the camp property, plant life or animals that live there. 

    ... make the world a better place, and

    • I agree to help other campers and staff keep camp clean and "leave no trace."
    • I agree to have an accepting and welcoming attitude toward others who have values and cultural experiences different from my own. 

    ... be a sister to every Girl Scout

    • I agree to be open to ideas other than my own and willing to cooperate with the other members of the camp community.
    • I agree to include all campers in my unit during camp activities.
    • I agree to do my best to have fun, try new things, make new friends, and enjoy my camp experience in the spirit of Girl Scouting.
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    GIRL SCOUT PROMISE

    On my honor, I will try
    To serve God and my country
    To help people at all times
    And to live by the Girl Scout Law.
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  • 62

    I understand and adhere to the Girl Scout Promise and Law. I have read the above and agree to the standards listed. I understand that failure to follow the guidelines listed will result in the following three steps:

    1.  I will be talked to by the leaders privately, warned that I have reached Step One

    2.  I will get a "time out".

    3.  Will be required to leave the event/camp. My parent/guardian will be called to come to the event/camp and pick me up. If my parent/guardian is unavailable to do so, my emergency contact will be called.

     

    I will also follow the rules of Benton Day Camp, always including the following:

    • A Girl Scout always leaves a place better than she found it; therefore, normal clean up is expected and no vandalism is allowed.
    • Each girl is expected to listen to her leader or the adults in charge at the event/camp, and respond respectfully to their directions.
    • Each girl agrees to give respectful cooperation to the adults in charge, who have the final say as to the rules.
    • Girls are NEVER to leave the designated Benton Day Camp event or area without a leader or parent.
    • Girls are expected to learn to think and act for the good of the group, as opposed to only themselves.

     

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    As a parent or guardian, I understand that my camper's inability to comply may result in my camper being prohibited from participating in specific activities, requiring immediate pickup by a parent/guardian, creating a behavior action plan with the parent/guardian, or not enjoying all of the opportunities Benton Day Camp has to offer. I understand that there is no refund for missed opportunities or dismissal from Benton Day Camp due to a violation of this agreement.

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  • 64
    Electronic Signature of CAMPER
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    for Electronic Signature
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    Electronic Signature of PARENT/GUARDIAN
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    for Electronic Signature
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  • 70

    Optional Hooded Sweatshirt

    We have a cool optional sturdy Benton Day Camp hooded sweatshirt with our original logo for campers, staff and all volunteers for $35.00. Stay warm and show your love for our Benton Day Camp all year round!

    To order our new camp hoodie, go to the Benton Day Camp Hooded Sweatshirt Order Form.

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  • 71

    Helping a camper family in need

    Please consider giving towards a Campership to help a camper, PAIT or PA go to Benton Day Camp.

    Just add $5.00 to your Registration Total.

     

    THANK YOU!

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  • 72
    Select all that apply
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  • 73

    CAMPERSHIP

    CAMPERSHIPS: Partial assistance is available to all girls. Download and complete the Campership Application and mail it to our Camp Registrar. After camp registration closes (June 15 or when camp is full), all the Campership Applications will be reviewed. Scholarships will be divided depending on number of applicants, need and funds available.

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  • 74
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    Remember to download and complete the Campership Application and mail it to our Camp Registrar.
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  • 76

    COOKIE OR NUT CREDITS

    Cookie or Nut Credits may be used to pay for all or part of camp fees.

    Credits may NOT be used for the optional sweatshirt.

    Credits may only be used by the girl who earned them.

     

    NOTE:  2026 Cookie Credits should be available early May. To save a spot for your camper, a minimum $25 deposit is required.  You could also just pay your remaining balance after Cookie Credits are subtracted from the registration fee total -- as long as your balance is at least $25.00.

    Please pay the $25 deposit or remaining balance via PayPal or check.

    Full payment is due June 1.

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    You may also take a picture of your card and email it to registrar@bentondaycamp.org
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    Registered Girl Scout

    $150
       

    Girl not currently registered as a Girl Scout -- new or renew membership (includes $45 Girl Scout membership for 2025-26 or up to 5 months of membership)

    $195

       

    Program Aide in Training (PAIT) who is a registered Girl Scout -- Girls entering Grade 7 or 8 in Fall 2026 -- Select the PAIT option when registering.

    Grade 7-9 girls not interested in the PAIT program will be placed in the Adventurers program.

    $175

    Program Aide in Training (PAIT) not currently registered as a Girl Scout -- Girls entering Grade 7 in Fall 2026 -- Select the PAIT option when registering. 

    Grade 7-9 girls not interested in the PAIT program will be placed in the Adventurers program.

    $220
       
    Program Aide (PA) who is a registered Girl Scout Cadette, Senior or Ambassador -- Girls entering Grade 8 or above in Fall 2026 (does not include PAITs)

    $75

    Program Aide not currently registered as a GS (includes $45 Girl Scout membership for 2025-26 or up to 5 months of membership)

    $120

    To save a spot for your camper, a minimum $25 deposit is required AND your completed Health History & OTC Meds Form.

    Full payment is due June 1.

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  • 80
    Determine your Registration Balance Remaining by subtracting the amount of Cookie/Nut Credits used from the Registration Fee  (Registration Fee - Cookie/Nut Credits used = ?)
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    Select one
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    PAYMENT BY CHECK

    Please make your check payable to Benton Day Camp. Send it to Elsie Sandin, Registrar, Girl Scout Benton Day Camp, 7540 NW Hood View Circle, Corvallis, OR 97330. Put the name of your camper in the Memo line.

     

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    PAYMENT BY PAYPAL or CREDIT CARD

    IMPORTANT:  You must click on the square with the correct amount to be directed to PayPal.

    $150 for Registered Girl Scout

    $195 for Not currently Registered as a Girl Scout

    $175 for Program Aide in Training (PAIT) and Registered Girl Scout

    $220 for Program Aide in Training (PAIT) and Not currently Registered as a Girl Scout

    $75 for Program Aide (PA) and Registered as a Girl Scout

    $120 for Program Aide (PA) and Not currently Registered as a Girl Scout

     

     

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    You MUST click on the square with the correct amount to be directed to PayPal
    prevnext( X )
    USD
    + OR enter a custom value
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    Go to the Volunteer page on our website to see our needs and where you can lend a hand.
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    Thank you for supporting Benton Day Camp 2026!

    Remember to submit your completed Health History & OTC Meds Form to save your camper's spot!

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  • 87

    Choose from one of the PayPal options to make your payment.

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