Troop/Group Extended Travel Form

Directions: Complete all required information if traveling more than 48 consecutive hours. Be sure to complete an Extended Travel Budget form and upload it to this form where asked.

Troop # *

Grades *

Service Unit # *

Your Service Unit Manager Name *

County *

Program Level *

Junior Cadette Senior Ambassador

Region *

I II III IV

Date/Time of travel - Departure *

- Month - Day Year

at

: Hour Minutes

Date/Time of travel - Return *

- Month - Day Year

at

: Hour Minutes

Destination *

Name of where you will be staying *

ie: hotel

Address of where you are staying *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Responsible Adult in Charge *

Responsible Adult's Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Email Address *

Phone Number *

- Area Code Phone Number

Number of Girls *

Ages of Girls *

Number of Female Adults *

Number of Male Adults *

All adults taking part in the trip must be registered members and have a current background check.
It is NOT permitted to include siblings of troop
members or leaders/advisors in the trip.

Names of All Girls Attending *

Names of All Adults Attending *

Transportation *

Auto/Van Commercial Aircraft Charter Bus Boat Train RV

Bus Company *

Type of Boat *

Name of Driver *

First Name Last Name

Driver Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Driver Cell Phone Number *

- Area Code Phone Number

Driver Troop Number *

Driver Auto Insurance Company Name *

Driver Auto Insurance Policy Number *

Driver Auto Insurance Policy Expiration Date *

If leasing a vehicle, follow the policy found in
Volunteer Essentials pages 46, 47.

Drivers MUST carry at least the minimum insurance
required by the laws of New York State.

Has your troop been on any trips before? *

Yes No

If 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 your trip?

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

Name of volunteer trained in Simply Successful Overnight

Date of SSO training

include copy of training card

Attach a Copy of SSO Training Card

Name of Volunteer trained in Simply Successful Camping (if applicable)

Date of SSC training

include copy of training card

Attach a Copy of SSC Training Card

Name of Volunteer trained in Extended Trips for Adults

Date of ETA training

Name of person certified in First Aid/CPR

Attach a copy of the First Aid/CPR certification

Certification

Level 1 Level 2

Expiration Date of FA/CPR Certification

- Month - Day Year

Name of Adult Certified Lifeguard (if required)

Expiration Date of Lifeguard Certification

- Month - Day Year

Please attach your Extended Travel Budget form (Estimate any costs that you don't have firm numbers for.)

Complete the Extended Trip Budget form and upload it here.

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

If you plan any money-earning projects in addition to the product sales, give details here.

When are you planning to conduct this money-earning project?

All money earning projects must be approved.
Please submit the Request for Money Earning Activity form

How much money do you plan to net?

Have you reviewed the Additional Money Earning Policy (Volunteer Essentials, page 88) and filed a Request for Money Earning Activity form?

Yes No

Activity Checkpoints reviewed

Yes No

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

Please attach your Extended Travel Budget form

This troop is recommended for travel by the SU Manager

Yes No

Service Unit Manager Name

Comments

Date Service Unit Manager Contacted

Need extra insurance

Yes No

Plans have been

Approved Not Approved

Comments

Travel Pathway Manager

Date

Troop/Group Extended Travel Form

Council Office Use