VRC Council Credit Reimbursement Form

This form is only for Volunteer Run Camp Admin to complete. This form is collecting information on each individual camper who is using their Council Credit to pay for camp. Please expect reimbursement 4-6 weeks after completing this form. If you are having any issues please contact volunteercamps@gsnorcal.org

Contact Information

Volunteer Run Camp: *

Person completing this form: *

Phone #: *

Email Address: *

Confirm: *

Make Check Payable to: *

Mail Check to (address): *

City: *

State: *

Zip Code: *

Reward Card/Council Credit Conversion Details

Girl's Name (1) *

Reward Card/Council Credit (1) # *

Council Credit Amount (1) $ *

Please check if this camper qualified for Dollar for Dollar Camp Match. Put the amount that should be pulled from this card under Council Credit amount. Council will double this amount if the camper qualifies and reimburse camp the total.

Girl's Name (2)

Reward Card/Council Credit (2) #

Council Credit Amount (2) $

Please check if this camper qualified for Dollar for Dollar Camp Match. Put the amount that should be pulled from this card under Council Credit amount. Council will double this amount if the camper qualifies and reimburse camp the total.

Girl's Name (3)

Reward Card/Council Credit (3) #

Council Credit Amount (3) $

Please check if this camper qualified for Dollar for Dollar Camp Match. Put the amount that should be pulled from this card under Council Credit amount. Council will double this amount if the camper qualifies and reimburse camp the total.

Girl's Name (4)

Reward Card/Council Credit (4) #

Council Credit Amount (4) $

Please check if this camper qualified for Dollar for Dollar Camp Match. Put the amount that should be pulled from this card under Council Credit amount. Council will double this amount if the camper qualifies and reimburse camp the total.

Girl's Name (5)

Reward Card/Council Credit (5) #

Council Credit Amount (5) $

Please check if this camper qualified for Dollar for Dollar Camp Match. Put the amount that should be pulled from this card under Council Credit amount. Council will double this amount if the camper qualifies and reimburse camp the total.

Girl's Name (6)

Reward Card/Council Credit (6) #

Council Credit Amount (6) $

Please check if this camper qualified for Dollar for Dollar Camp Match. Put the amount that should be pulled from this card under Council Credit amount. Council will double this amount if the camper qualifies and reimburse camp the total.

Girl's Name (7)

Reward Card/Council Credit (7) #

Council Credit Amount (7) $

Please check if this camper qualified for Dollar for Dollar Camp Match. Put the amount that should be pulled from this card under Council Credit amount. Council will double this amount if the camper qualifies and reimburse camp the total.

Girl's Name (8)

Reward Card/Council Credit (8) #

Council Credit Amount (8) $

Please check if this camper qualified for Dollar for Dollar Camp Match. Put the amount that should be pulled from this card under Council Credit amount. Council will double this amount if the camper qualifies and reimburse camp the total.

Girl's Name (9)

Reward Card/Council Credit (9) #

Council Credit Amount (9) $

Please check if this camper qualified for Dollar for Dollar Camp Match. Put the amount that should be pulled from this card under Council Credit amount. Council will double this amount if the camper qualifies and reimburse camp the total.

Girl's Name (10)

Reward Card/Council Credit (10) #

Council Credit Amount (10) $

Please check if this camper qualified for Dollar for Dollar Camp Match. Put the amount that should be pulled from this card under Council Credit amount. Council will double this amount if the camper qualifies and reimburse camp the total.

Electronic Signature

Electronic Signature By typing my name on this form, I am entering my "electronic signature" (as defined in The California Uniform Electronic Transactions Act 1633.1 - 1633.17) and certifying that I have read, fully understand and accept all terms of this agreement.

Please type your full name here: *

Published December 15, 2023

* Please Note: Once you submit this form, you'll have the option to print the form contents on the following page.

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