Every Girl in a Tent Patch Request Form All current girl members of Girl Scouts River Valleys who spend at least one night in a non-permanent structure can earn an exclusive glow-in-the-dark Every Girl in a Tent patch. After your trip, simply share your tent camping story and a few other details by filling out this form. 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 Are you a service unit volunteer requesting patches for an upcoming service unit encampment?*YesNoTroop Number*Service Unit Number*Program Level*Check all that apply. Daisy Brownie Junior Cadette Senior Ambassador Number of girls who participated*Month of your camping trip(s).*Check all that apply. January February March April May June July August September October November December Number of nights you camped during each trip.* Click the (+) button to add an additional trip.Please select your camping method.*Check all that apply. Tent Hammock Quinzhee Other Please list other camping method if not listed above.*How was your tenting experience arranged.*Check all that apply. Troop event Service Unit event Council event Resident camp Family event Where did you camp?*Check all that apply. State Park National Park Local or Regional Park Girl Scout property Backyard Other Please list other camping location if not listed above.*Name or location of your camp*Share a camping highlight, special skill learned, or fun story from your trip.*Share a photo from your trip. Drop files here or Accepted file types: jpg, png, pdf, tif, pdf. Which girl patches are you requesting?*Check all that apply. Every Girl in a Tent patch 5 night 10 night 15 night 20 night How many Every Girl in a Tent patches are you requesting?*How many 5 night patches are you requesting?*How many 10 night patches are you requesting?*How many 15 night patches are you requesting?*How many 20 night patches are you requesting?*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.