Adventure Club Patch Request Form All girls who participate in three Adventure Club activities can earn the Adventure Club patch. After you complete all three activities, simply share your story and a few other details by filling out this form. Activities must have been completed after September 1, 2018. The patch request form may be submitted year round. Patches will be mailed after each of the following dates in 2019. January 31 May 31 July 31 September 30 Your Name* First Last Your Email* Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Troop Number*Program Level*Check all that apply. Daisy Brownie Junior Cadette Senior Ambassador Number of girls who participated*How many Adventure Club activities did you do?*ThreeSix or moreWhat types of Adventure Club activities did you participate in?*Check all that apply. Hiking Camping Rock Climbing/Indoor Climbing Biking Caving Snowshoeing Skiing Art in the Outdoors Kayaking Canoeing Backpacking Other Please list other activity if not listed above.*Through what type of event was your activity arranged?*Check all that apply. Council event Service Unit event Troop event Other Please list other event type if not listed above.Which girl patches are you requesting?*Check all that apply. Adventure Club Patch (completed at least 3 Adventure Club activities) Adventure Club Pro Patch (completed 6 or more Adventure Club activities) How many Adventure Club Patches are you requesting?*How many Adventure Club Pro Patches are you requesting?*Share a highlight, special skill learned, or fun story from your adventure.*Share a photo from one of your adventures. Drop files here or Accepted file types: jpg, png, pdf, tif. Are there any other types of Adventure Club activities you would like to see offered by the council?I understand that the photographs, writing, artwork, audio, or video I am submitting (collectively referred to hereafter as “material”) may be used for any lawful purpose by Girl Scouts River Valleys or its approved media partners. I hereby hold Girl Scouts River Valleys free and harmless of any and all liability arising out of the subsequent publication and use of the submitted material.* Yes, I accept these terms.