Troop/Group Activity Application

All troop/service unit/group activities involving an overnight stay, a high-risk activity, or travel of more than 200 miles round trip from your normal meeting place require
council approval.

Interim COVID-19 Guidance for Volunteers: Please continue to follow GSNYPENN's Volunteer COVID-19 Guidelines found on our website.

Troop meetings and events hosted in a private home or yard require completion of the Home Safety Checklist with site approval.

Troop/Group Information

Troop #/Group Name *

Service Unit # *

County *

Grade Level *

Daisy Brownie Junior Cadette Senior Ambassador

Type of Trip *

High Risk Activity (i.e. whitewater rafting, horseback riding and ropes course) Day Trip (first aider required) Indoor/Lodging Camping or Overnight (first aider and SSO required) Outdoor/Tent Camping (first aider and SSC required) Extended Trip is a trip over 48 hours Other

Leader's name *

First Name Last Name

Leader's mailing address *

Street Address

Street Address Line 2

City State

Zip Code

Leader's Mobile Phone *

Leader's email address *

example@example.com

Activity Description *

List precautionary steps being taken to prevent COVID-19 transmission *

Estimated Mileage (Round Trip) *

Destination name, address, and phone number *

What type of accommodations are being used for this trip?

Hotel or motel Property Rental (VRBO, Airbnb, HomeAway) Camping Other

Property rentals through VRBO, Airbnb, and HomeAway are permitted. However, because these are privately owned properties, it can be difficult to qualify safety and credibility. For these reasons, additional steps for these rentals are required. By checking the boxes below you are agreeing that you have already confirmed these specifics ahead of time:

	Verified	Not Verified
The rental is for exclusive use of the home. No other renters will have access to the home during the rental period.
The space has smoke alarms, carbon monoxide detectors, and fire extinguishers (these are noted as amenities on the booking sites)
The home and host have substantial, positive visitor reviews. Do not book places with negative, few, or no reviews. Look for super-host status on Airbnb.
The liability insurance from the host covers premises for commercial use with a minimum of one million dollars General Liability insurance.
Check the host's profile or identity verification. You may be asked to do the same, as the renter.
The local host or manager contact info is available for immediate needs. Share this information with an in-town contact (person not on the trip)
Check state laws to see if Airbnb, VRBO, and HomeAway are mandates to meet hotel laws and standards so that you know there is an extra layer of protection.

If "other" is selected, please specify

Departure date and time *

Month Day Year

Hour Minutes AM/PM Option

Return date and time *

Month Day Year

Hour Minutes AM/PM Option

Please list the types of activities planned for this trip. *

How is this trip being funded? *

How is girl and adult planning incorporated? What steps have been taken to ensure troop readiness? *

Has your troop been on any trips before?

Yes No

Is yes, where and how long?

What plans have you made to educate your girls about traveling?

How does this trip relate to your planned troop program?

Are you using regularly scheduled troop meetings to plan your trip?

Yes No

If yes, what arrangements have you made for girls who will NOT be going on the trip?

Unless ALL troop members are going on this trip, it is strongly recommended that you schedule separate meeting times for your trip planning.

Required Adult Trainings

Name of First Aid and CPR Chaperone *

Fiirst Name Last Name

First Aid Chaperone phone # *

Type of First Aid and CPR certification *

We accept American Red Cross, National Safety Council, EMP of America, American Heart Association trainings

First Aid expires

MM/DD/YR

CPR expires

MM/DD/YR

For Indoor Lodging Camping or Overnight

Name of SSO Trained Chaperone (may not be first aider): *

First Name Last Name

Phone Number

SSO Course Location:

SSO Course Date:

MM/DD/YR

For Outdoor/Tent Camping

Name of SSC Trained Chaperone (may not be first aider):

First Name Last Name

Phone Number

SSC Course Location:

SSC Course Date:

MM/DD/YR

For Extended Travel

Name of Extended Travel trained Chaperone:

First Name Last Name

Phone Number

Please enter a valid phone number.

Extended Travel Training Date

What is your plan for the girls who will not be able to participate due to cost?

If planning to complete Money Earning Activities, have you completed the Money Earning Request?

Yes, already completed No, I plan to submit NA

All money-earning activities must be approved.

Please submit the Request for Money Earning Activity form.

Please attach you Extended Travel Budget form *

Emergency Contact

Does your location have cell service to call 911? *

Yes No

If not, name local fire and rescue numbers that you will use in an emergency.

Emergency on-site phone/cell number (A leader or approved adult on location at the trip.)

Emergency off-site phone/cell number (The person who is available by phone during the trip and has a list of names, addresses, and phone numbers of those attending. This contact is not on the trip; it is someone local.)

Transportation

Vans with a seating capacity of more than 10 passengers are prohibited. Please assure that all drivers are approved volunteers (background checked) and have a current driver's license and car insurance. *

Individual Public Leased/Rented Vehicle (requires council approval and signatures on contracts) Leader/Adult vehicle Chartered bus (requires council approval and signatures on contracts) Other

Safety Checkpoints

First Aid Kit Health History Forms Updated Parent Permission Slips Lifeguard Boating/Small Craft Certified Chaperone Reviewed Safety Activity Checkpoints (http://www.gsnypenn.org/en/for-volunteers/safety-activity-checkpoints.html) Additional insurance is required for non-registered adults or tagalongs? (If yes, contact Customer Care at 800-943-4414.)

List the Safety Activity Checkpoints that were reviewed

Located on line at http://www.gsnypenn.org/en/for-volunteers/safety-activity-checkpoints.html

Participant Names

Girls *

Adults* *

*For the safety of all girls, all adults going on your trip must be registered and have a current background check on file with GSNPENN.

It is NOT permitted to include siblings of troop members on trips.

Please contact Customer Care at 1-800-943-4414 with questions.

Extra insurance can be obtained by emailing info@gsnypenn.org at least three weeks before the start of your trip.

Certification

I hereby certify that the above information is correct. I have reviewed safety standards and will be responsible to see that all participating girls and adults meet the requirements.

Type leader's digital signature *

Date *

Month Day Year

Comments

Troop and Group Activity Application