This form is for the purchase of Plan 2 insurance which covers accidents only for non-registered Girl Scout members. Other types of insurance plans are available here.
The cost for insurance is set by Mutual of Omaha and is subject to change without notice. The estimated cost is calculated as follows: number of non-registered participants x number of trip/event days x 11 cents. For example 25 participants x 5 days x 11 cents = $13.75. NOTE: The minimum insurance cost is $5.00 therefore if the total calculated cost is less than $5, then the amount owed is $5.00.
This form needs to be submitted 2 weeks prior to an event/trip for ample processing time. Submitting this form in less than 2 weeks prior to your event/trip may result in an inability to secure Plan 2 additional insurance.
If you need to purchase insurance for more than 3 events/trips, please use the writeable form found here.
Please contact Customer Care at firstname.lastname@example.org or 1-800-922-2770 with any questions.
Please be sure to complete the form in its entirety and enter payment information. You must click "SUBMIT" in order for your insurance request to be processed.