Day Trip and Simple Overnight Troop Trip Travel Application

Troop Information
Service Unit
Troop Number
Age Level of Girls
Total Number of Participants
Number of Girls
Number of Registered Adults
Number of non-registered person(s)
Please provide a Roster of ALL adults and girls participating in the trip by typing their information below. If all girls in your troop are attending, please input "all girls." By noting "all girls," you acknowledge that this list includes all girls currently listed on your troop roster. Additions to this group must be listed. If all adults are attending, please list ALL adult names so that we may verify that each attending party has a membership and a background check. Adults who are dropping off their girl, or who are not staying for the duration of the event, do not need to be listed.
Please list ALL attending girls and adults below:
I have reviewed in Volunteer Essentials the required adult volunteer/girlratios for Events, Travel, and Camping, and confirm that the minimum ratiowill be met for this trip.

Trip Information
Trip Destination
Destination Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Departure Date

MonthDayYear
Date
Departure Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Return Date

MonthDayYear
Date
Return Location Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
NOTE:

If High Risk Activities are scheduled, include all participants high-risk
activity forms with this application.

Make sure parent/guardian permission forms are collected prior to
the trip, and Girl Health History forms are available to the First Aider on the
trip.
In accordance with Safety Activity Checkpoints, will your troop be participating inany activities that require council approval/ high risk?

Transportation
What type of transportation will be used on the trip? (Select all that apply)

Other
Name of Rental or Bus Company (if applicable)
Driver 1 - Full Name

First NameLast Name
Driver 1 - Driver's License Number
Driver 1 - Insurance Company
Driver 2 - Full Name (if no other adults will be driving, please skip down to the next section)

First NameLast Name
Driver 2 - Driver's License Number
Driver 2 - Insurance Company
Driver 3 - Full Name

First NameLast Name
Driver 3 - Driver's License Number
Driver 3 - Insurance Company
Emergency Contact Information:

Home Emergency Contact Person. Provide name of person at home to serve as
troop contact in case of emergency. Please provide the emergency contact person
with a copy of the itinerary, an emergency action plan and contact information
for the caregivers of everyone attending. This person must be someone who is not
attending the trip.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I have researched and identified the nearest hospital or emergency medicalprovider for the trip destination

Adult Training and Certification

The adults listed below are participating on this trip and have completed the necessary training for this trip.
First Aid & CPR Certified Adult - Full Name

First NameLast Name
Please submit a copy of this certification to program@gswrc.org
Troop Camp Certified Adult - Full Name (if applicable)

First NameLast Name
Date of Completion

MonthDayYear
Date
Planning Trips with Girl Scouts Trained Adult (for overnight trips) - Full Name

First NameLast Name
Date of Completion

MonthDayYear
Date

Itinerary and Accommodations
For trips that have multiple stops or a complex itinerary of activities, please share additional details here including dates, approximate times, daily activities, and major sites or stops.
Complex itineraries can be sent to program@gswrc.org
Accommodations (Select all that apply)

Other
If applicable, please provide the name and address for each overnight accommodation.
Accommodation 1 - Name
Accommodation 1 - Address
Accommodation 2 - Name
Accommodation 2 - Address

Signature
I affirm that I have reviewed the travel requirements and applicable Safety Activity Checkpoints for this trip
This trip has been planned with girl input at a level appropriate for the girls’ grade level and progression.
My signature below indicates that all the information provided is correct to the best of my knowledge. I also acknowledge that intentional failure to follow published guidelines and procedures found in the most current version of Volunteer Essentials and Safety Activity Checkpoints could result in a reduction of available Girl Scout provided insurance and may result in personal liability to myself. I understand that all travel approval is tentative until the final approval email notification is received.
Signature
Printed Name

First NameLast Name
Should be Empty:

Trip Coordinator