Simple Overnight Trip Application

Simple Overnight Trip Application
This application is used for simple overnight trip of two (2) or less nights duration. Applications should be submitted at the time of initial planning and no later than six (6) weeks prior to the date of departure. While it’s rare, some trips may need altered to meet Girl Scout guidelines. Confirmation will be provided within ten (10) days of receipt.
- All participants must be currently registered Girl Scout members.
- All adult chaperones must be currently approved volunteers with completed background checks.
- All trips require a First Aid/CPR trained adult.
- Refer to Chapter 4: Safety-Wise of Volunteer Essentials. Review all Safety Activity Checkpoints.
- Refer to Volunteer Essentials, Appendix II: For Travel Volunteers
- All binding contracts must be submitted to GSNEO for approval (i.e. van rentals, bus rentals, etc.).
- If needed, additional insurance or paperwork will be included in the confirmation information.
For extended trips of three (3) or more nights duration or international trips use this form.
Section 1. Trip Coordinator
Name*

First NameLast Name
5-digit Troop Number*
Phone*
By checking this box, I consent to receive customer care and account notification text messages (SMS or MMS) from Girl Scouts of North East Ohio. You may opt-out at any time by replying STOP. For assistance, text HELP. Message frequency varies. Message & Data rates may apply. View TERMS (gsneo.org/terms) and PRIVACY (gsneo.org/privacy).
E-mail*
Section 2. Description of Destination

Please provide a brief description of the trip.
Name of Destination*
Destination Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Departure Date (Pick a Date)*

MonthDayYear
Return Date (Pick a Date)*

MonthDayYear
Section 3. Trained Volunteers & Activities

Provide names of volunteers attending the trip with the following qualifications.
First Aid/CPR Certification*
Date First Aid/CPR Certification Expires (Pick a Date)*

MonthDayYear
First Aid/CPR Certification*

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Outdoor Essentials (for camping trips)
Date Trained (Pick a Date)

MonthDayYear
Outdoor Essentials Certification

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Check any other specialized certifications and list certified person below:

LifeguardSmall Craft SafetyBasic Water RescueArchery
Specialized Certification Person #1
Date Specialized Certification Expires (Pick a Date)

MonthDayYear
Specialized Certification

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Specialized Certification Person #2
Date Specialized Certification Expires (Pick a Date)

MonthDayYear
Specialized Certification

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Activities included in the trip: (the activities listed below require a Hold Harmless form and/or specialized certifications.*

Horseback RidingBoating/RaftingSwimmingZip LiningNo High Risk activities are planned.Other
Section 4. Emergency Contact Information and Transportation
Home Emergency Contact Person. Provide name of person at home to serve as troop contact in case of emergency.

Please provide the emergency contact person with a copy of the itinerary, an emergency action plan and contact information for the caregivers of everyone attending.
Name*
Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
I have researched and identified the nearest hospital or emergency medical provider for the trip destination*

YesNo
Transportation (check all that apply)*

Private Car(s)Chartered BusRented VehicleAirplaneTrainBoat/ShipOther
Accommodations (check all that apply)*

HotelCampsitePrivate HomeOther
Section 5. Number of participants and Trip Roster
# Girls*
# Adults*
Please indicate the number of girls for each program age level:
# of Daisies (K-1)*
# of Brownies (2-3)*
# of Juniors (4-5)*
# of Cadettes (6-8)*
# of Senior (9-10)*
# of Ambassadors (11-12)*
Provide a Roster of all girls and Adults participating in the trip. Remember, everyone attending must be a registered Girl Scout and Adults must have a current background check.*

Roster is attached below.Roster has been typed in below.
List all ADULTS participating in the trip:
List all GIRLS participating in the trip:
Attach a trip roster.

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Section 6. Annual Finance Report
Have you completed your most recent Annual Finance Report?*

YesNo
Please state why you have not completed it.
Section 7. Communicable Illnesses Accommodations
What accommodations are you making to account for new/changing requirements related to communicable illnesses?
I understand that my typed name below serves as my digital signature.
Type Full Name for Digital Signature*
Should be Empty: