Additional Insurance

Additional Insurance Request

All registered Girl Scout members and invited non-members participating in a Girl Scout sponsored and supervised activity are covered by Plan 1 insurance, paid by their membership fees; this plan covers approved daytime activities or overnight activities. For all other activities, participants must be covered by additional insurance. Additional insurance is required for non-members and tagalongs who are NOT participating in a Girl Scout sponsored and supervised activity, and all foreign travel.
Purchaser's Name:*

First NameLast Name
Enter Troop Number or Staff*
Purchaser's Email*
example@example.com
Purchaser's Phone Number:*
Please enter a valid phone number.
Event Start Date:*

MonthDayYear
Event End Date:*

MonthDayYear
Event Name or Description:*
Event Location: *
Event Activities: *
*What will you be doing?
Program Grade Level(s):*

DaisyBrownieJuniorCadetteSeniorAmbassadorAdultTagalongs
How many registered girls are attending? *
How many registered adults are attending?*
How many non-registered adults are attending? *
*This includes boys 13 years old or older.
How many Tagalongs are attending? *
*Girls under 5 and boys under 13 are considered tagalongs - DO NOT include adults.
How many boys under the age of 12 are attending? *
Total number of participants are attending? *
Please Choose One: *
We will call you to get your payment information once we have purchased the insurance. The average cost is $.29 per person attending your event. There is a minimum purchase amount of $5. You will receive an email with the amount and a copy of the receipt.
Date Purchased
Date Run Through Shop
Amount Run Through Shop
Should be Empty:

Additional Insurance Request

We will call you to get your payment information once we have purchased the insurance. The average cost is $.29 per person attending your event. There is a minimum purchase amount of $5. You will receive an email with the amount and a copy of the receipt.