Application for Activities and Trips (P500)

Application for Activities and Trips (P500)

Please complete and submit this form a minimum of 4 weeks prior to trip. This form must be approved before girls proceed with planning! You will be notified of the status of your application within 10 business days of receipt of your request.
Troop Number*
Name of contact submitting this form*

First NameLast Name
Email of contact submitting this form*
example@example.com
ACTIVITY/TRIP INFORMATION
Name of Activity*
ie: trip to the zoo
Check all boxes that apply to your trip/activity*

Tagalongs (children under the age of 18 that are not registered Girl Scouts) will be attending this activity/tripThis activity/trip requires the troop/group to travel more than 350 miles round-tripThis activity/trip is for international/cruise travel.This activity/trip last more than 2 consecutive nights (3 nights when one of those nights is a federal holiday)This activity/trip occurs at a GSLPG Camp PropertyThis activity/trip involves one or more high risk activitiesThis activity requires council approval as stated in the Safety Activity Checkpoints.
Name of primary contact during this activity*

First NameLast Name
Contact number of primary contact during this activity

Area CodePhone Number
Email of primary contact during this activity*
example@example.com
Upload your trip itinerary *

Browse Files

Cancelof
Activity/Trip Start Date*

MonthDayYear
Date
Activity/Trip Start Time*

:HourMinutesAM/PM Option
Activity/Trip End Date*

MonthDayYear
Date
Activity/Trip End Time*

:HourMinutesAM/PM Option
Departure Location*
Departure Location Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Activity/Trip Location*
Activity/Trip Location Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the purpose of this activity/trip?
Is this activity/trip an overnight?*

YesNo
Name of Overnight Accommodations*
Phone number of Overnight Accommodations*

Area CodePhone Number
Address of Overnight Accommodations*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
At Home Emergency Contact Information

Please note that this person should not be a participant of this activity or trip.
Name of Emergency Contact*

First NameLast Name
Daytime phone number of Emergency Contact*

Area CodePhone Number
Evening phone number of Emergency Contact*

Area CodePhone Number
Participant Information
Number of Registered Girl Scouts participating in this Trip/Activity*
Number of Registered Adult Girl Scouts participating in this Trip/Activity*
In the table below, please add the number of participants that represent each catagory*
General Budget Information (An itemized budget may be requested if needed)*
Transportation Information (Indicate what type of transportation is being used - check all that applies)*

Registered Adults in the Troop will be transporting girls to this trip/activity in their private vehicles.Lease or chartered bus (if leasing or chartering transportation, please include the Hired, Leased or Borrowed Vehicle Form located in the forms section of our website.TrainAirplaneWatercraftParents are driving their own children to the activity.
List the names of the registered adults that will be driving girls to this activity/trip.*
CERTIFICATIONS: List adults who are participating on this trip/activity and the completed necessary training for this trip.
PARTICIPANT INFORMATION: List below all participants that are planning to attend this activity/trip*
Advisor/Leader Statement of Compliance
- I have reviewed the policies for this activity found in Volunteer Essentials, Safety Activity Checkpoints, and GSLPG’s travel, health, safety, and emergency procedures, and the policies are being adhered to.
- All certified adult participants can perform in their capacities according to GSUSA health and safety guidelines.
- All drivers for these activities are properly licensed and all vehicles are registered, insured, maintained, and have a seat and seatbelt for every passenger.
- Parents/guardians are informed of the trip activities, safety and emergency procedures, and contact information.
- A Girl Scout Permission Slip (P-518) either has been or will be obtained for each girl including Girl/Adult Health History (TO-508) by the date of the activity.
- The group will be accompanied by a minimum of 2 registered, non-related adults. One must be a female. Additional adults will be added as required by GUSUA Safety Activity Checkpoints.
- Our group/troop will conduct ourselves always in a positive manner while representing Girl Scouts.
- If my trip or activity is considered high risk, I have confirmed that the location or facility has current and up-to-date liability insurance.
- I understand providing misinformation could result in the trip not being covered by Girl Scout Activity Insurance and could increase personal liability.
Troop Leader Signature
I certify that all information listed is this application is correct to the best of my knowledge. I certify that I agree to comply with the above statement of Compliance*

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