2026 Fall Product Juliette Agreement & Permission Form

2026 Fall Product Program

Juliette Product Program Agreement and Permission Slip
Juliette Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Parent/Caregiver Name

First NameLast Name
Best Contact Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Caregiver is a 2027 registered member of the Girl Scouts of Eastern MA (all parent/caregivers must be a registered member in order for Girl Scout to accept paper orders or girl delivery)
The parent/caregiver has a current, approved GSEMA CORI (all parent/caregivers must have an approved GSEMA CORI that is valid throughout the Fall Program in order to collect money from customers during the Fall Product Program).
My Juliette will be participating with a troop during the Fall Program.
Please provide troop number here
NEW! All levels may Opt-Out of rewares (Daisy, Brownie, Junior, Cadette, Senior and Ambassador) Juliette's may choose to opt-out of the rewards program and earn an additional $0.05 per earnings level (see Juliette Guide for details). Check below if your Juliette would like to participate in the opt-out option.
In the absence of a designated Service Unit Fall Product Mentor for the service unit/town, please indicate the preferred council service center for product/reward pickup
Has your Juliette submitted a Gold Award project proposal and would like to apply earned funds (Program Credits) toward funding their project?
I understand that in signing this form, I affirm that the information I have given is true, complete and correct.
Parent/Caregiver Signature
Should be Empty:

2026 Fall Product Program