Supplemental Insurance Request Form

All current Girl Scout members are automatically covered under a basic activity accident insurance plan. This plan covers registered members for supervised Girl Scout activities lasting two consecutive nights or less. It allows members to recoup any out-of-pocket expenses from an accident that may have taken place during an approved Girl Scouts Activity or overnight trip.
As of Oct 1, 2023: If you are coordinating an event or activity in which non-members are invited, they are also covered under this insurance. This includes young children of troop volunteers at Girl Scout meetings. There is no need to request supplemental insurance.
As requested under Travel Approval Worksheet (PDF): If you are planning a Girl Scout activity that will last longer than two consecutive nights, like an extended trip, please fill out the Supplemental Insurance Request Form below for extra coverage of participants. This covers out-of-pocket expenses for both accidents and illnesses.
Girl Scouts River Valleys will use this information to purchase additional insurance coverage on your behalf. Girl Scouts River Valleys must receive this form at least one month prior to your activity to be able to process.

Please Note: If an organization or property owner that you are working with requests proof of insurance, what they are requesting is a Certificate of Insurance (COI). Use the Certificate of Insurance Request Form for those requests.

Type of Activity*

Travel within the United StatesInternational Travel

Name*

First NameLast Name

Email*

example@example.com

Troop Number or Service Unit Number*

To look up your service unit name or number, see our service unit directory.

List all travel participants. (All fields are required)*

Total Number of Travelers*

Destination City*

Destination State*

Destination City/Town*

Destination Country*

Departure Date*

MonthDayYear

Return Date*

MonthDayYear

Supplemental Insurance Request Form

Travel Information