• Optional Accident Insurance - Plan 2

    Enrollment Form for Optional Accident Insurance for Girl Scout Activities or Events
  • 1. This form MUST be received in the council office with payment at least two weeks prior to your event.

    2. Once completed enrollment form is received by Girl Scouts of Central Indiana, the council will submit your enrollment information and premium to the insurance company.   Council approval is required - troop leaders/volunteers should not submit emrollments directly to insurance company.

    3. There is a $5.00 minimum charge.

  • Please provide accident insurance to cover all enrolled partipants in the following approved, supervised Girl Scout activities (except statutory employees covered under workers' compensation) 

    Several events may be included on one enrollment form to meet the minimum.

  •  
  • prev next ( X )
    Premium Each Day at $.11 Total Number of Participants multiplied by (x) number of days = Quantity for Premium Insurance
    $ 0.11
       
    Minimum Charge Difference to Minimum Charge of $5.00
    $ 0.01
       
    Total
    $ 0.00

    Payment Method
    Credit Card
    Billing Address
  • Should be Empty: