Troop Trip & High Risk Activity Request Form

Troop Trip & High Risk Activity Request Form
If your troop is meeting somewhere other than your normal location/time, doing a high risk activity OR if your troop is going on a trip together, this form will guide you in providing the necessary information to GSMW, therefore aligning your activity/trip for required Girl Scout Insurance standards.

For approval, you MUST submit this form at least two weeks before the trip/activity.

When submitting this form, please be aware that this IS NOT a savable form, so be prepared to include or upload the following information:
- Roster of all participants, adult and child, with phone numbers - adults must be registered and background checked to serve as chaperones for the troop
- Tagalongs are discouraged
- Detailed travel itinerary (including start/end dates, addresses & times)
- Name(s) of adult(s) certified in applicable trainings and date of certification (i.e. CPR & First Aid, Outdoor Training, Lifeguard, etc.)
- Transportation plan including drivers, passengers, license numbers, and vehicle and auto insurance details
- Additional insurance form (if non-Girl Scouts are attending OR for a trip lasting longer than 3 days and 2 nights)
- If your trip requires council approval, each minor and adult participant will need to have a COVID-19 Activity Participant Waiver on file with GSMW before the trip can receive GSMW approval. Trip leaders can submit the group's waivers altogether via scanned documents to customercare@gsmw.org .
IMPORTANT DOCUMENTS TO REVIEW
- Review Volunteer Essentials (Appendix: For Travel Volunteers)
- Review Safety Activity Checkpoints
- Review High Risk Activity List
- COVID-19 Activity Participant Waiver
- COVID-19 Activity Participant Health Form
Navigating the Troop Trip & High Risk Activity Request Process

Is this trip for a Council Sponsored Program? *

Yes No

Is this an overnight trip? *

Yes No

Is this trip local within your community? *

Yes No

Is this overnight trip for 2 or more nights? *

Yes No

Do any of the activities listed below apply to your group travel? *

Yes, please select those that apply below. No
Type of Activity (select all that apply)

Outside of council jurisdiction Special site, equipment and/or instructor. NOTE: Providers must have proper certifications and liability insurance (check Safety Activity Checkpoints). Sensitive and/or controversial topic Renting a special site Hiring a bus driver or other transportation service Foreign travel High-risk council approved activity (see below)
Review Safety Activity Checkpoints.

Based on your answers provided, your Troop Trip DOES NOT require the full Troop Trip & High Risk Activity Request Form.

Rather, you are simply required to provide the information below no later than two weeks before your planned departure date.
Troop Trip Details
Adult Leader's Name *

First Name Last Name
Troop Number *
Email *
example@example.com
Phone Number *

Area Code Phone Number
Attendees

Please review Girl Scout Adult-to-Girl Ratios Guidelines.

Girls Attending *

# Attending

Daisies

Brownies

Juniors

Cadettes

Seniors

Ambassadors

TOTAL GIRLS

Adult Chaperones Attending *

# Attending

Female Chaperones

Male Chaperones*

TOTAL ADULT CHAPERONES

*If you have a male chaperone, you MUST also have one unrelated female chaperones.
Trip Destination *
Purpose of Activity / Trip *
Start Date *

Month Day Year
Date
Start Time

: Hour Minutes AM/PM Option
End Date *

Month Day Year
Date
End Time

: Hour Minutes AM/PM Option
Emergency Contact

Someone who knows your plans, is not participating in the activity, and has a list of participants with contact information of parents/guardians.
Emergency Contact Name *

First Name Last Name
Phone Number (cell / work / daytime) *

Area Code Phone Number
Phone Number (evening)

Area Code Phone Number
Signature of adult leader or event coordinator *

I certify that I have read and will follow any Safety Activity Checkpoints applicable to our travel plans.
Review Safety Activity Checkpoints
*

First Name Last Name
Month Day Year
Date
G.I.R.L. Card Redemption

If you have G.I.R.L. Gift Cards to redeem, please be aware that they are non-transferable and must be used for the girl that earned them.

Card Details (see image below)

Girl Scout Name

Card Number

CVV Code (on back)

$$ Amount to Use

Card #1

Card # 2

Card #3

Card #4

Card #5

Card #6

Card #7

Card #8

Card #9

Card#10

Type of Activity (select all that apply) *

Non-local overnight trips Extended travel (3+ nights) Outside of council jurisdiction Special site, equipment and/or instructor. NOTE: Providers must have proper certifications and liability insurance (check Safety Activity Checkpoints). Sensitive and/or controversial topic Renting a special site Hiring a bus driver or other transportation service Foreign travel High-risk council approved activity (check Safety Activity Checkpoints)
Review Safety Activity Checkpoints.

Troop Details
Troop Leader / Event Coordinator *

First Name Last Name
Troop Number(s) *
Service Unit
Email *
example@example.com
Phone Number (cell / work / daytime) *

Area Code Phone Number
Phone Number (evening)

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Attendees

Please review Girl Scout Adult-to-Girl Ratios Guidelines.

Girls Attending *

# Attending

Daisies

Brownies

Juniors

Cadettes

Seniors

Ambassadors

TOTAL GIRLS

Adult Chaperones Attending *

# Attending

Female Chaperones

Male Chaperones*

TOTAL ADULT CHAPERONES

*If you have a male chaperone, you MUST also have one unrelated female chaperones.
Emergency Contact

Someone who knows your plans, is not participating in the activity, and has a list of participants with contact information of parents/guardians.
Emergency Contact Name *

First Name Last Name
Phone Number (cell / work / daytime) *

Area Code Phone Number
Phone Number (evening)

Area Code Phone Number

Activity Details
Trip Destination *
Start Date *

Month Day Year
Date
Start Time

: Hour Minutes AM/PM Option
End Date *

Month Day Year
Date
End Time

: Hour Minutes AM/PM Option
Description of Activity / Trip *
Has a signed Activity Permission / Health History Card been obtained for each participant? *

Yes No, but I am aware that I need to collect these before the trip
Does the trip meet council recommended adult to girl ratios? *

Yes No
Review Adult to Girl Ratios.
Activity Budget

Please note that GSMW does not encourage the use of troop funds for adult travel expenses.
Total Cost *
How much will each girl pay? *
How much will each adult chaperone will pay? *
How much will the troop pay? *
Other Income Source
G.I.R.L. Card Redemption

If you have G.I.R.L. Gift Cards to redeem, please be aware that they are non-transferable and must be used for the girl that earned them.

Card Details (see image below)

Girl Scout Name

Card Number

CVV Code (on back)

$$ Amount to Use

Card #1

Card # 2

Card #3

Card #4

Card #5

Card #6

Card #7

Card #8

Card #9

Card#10

Certified Adults - CPR & First Aid

All groups going on a non-local trip are REQUIRED to have a current CPR and First Aid certified adult chaperone with the group at all times.
Does your group have a certified CPR and First Aid trained adult? *

Yes, I'll provide this info in the next section We will be going on a LOCAL trip where the high risk activity provider is CPR and First Aid certified No, we do not (you will not be able to move forward with this request form)

Name of CPR and First Aid certified adult chaperone(s) - BOTH ARE REQUIRED *
Date CPR and First Aid Training Completed *
Certification Expiration Date *
CPR and First Aid Certification Provider *

Since you selected that you DO NOT have a CPR and First Aid Certified adult with your group, you will not be able to move forward from this point.

You are required to have a CPR and First Aid certified adult chaperone with your group at all times when traveling.

If you are traveling locally and attending a High Risk Activity, please confirm if the provider will have a CPR and First Aid certified leading the activity. If so, please hit the 'Back' button below and select that answer once confirmed. Then you will be able to move forward and complete the rest of the form.

If you are waiting for an adult in your group to become certified, you will need to come back and complete this form once the certification is complete.

If you have any questions, please contact Customer Care.

Certified Adults - Activities
Does your activity require a trained activity supervisor/instructor according to Girl Scout Safety Activity Checkpoints? *

Yes No
Review Safety Activity Checkpoints.

Certified Adults - Activities
Name of trained activity supervisor(s) (i.e. lifeguards, canoe instructor, etc.) *
Type of Activity Certification *
Date Activity Training Completed *

Certified Adults - Outdoor Training
Will your troop be camping or cooking outdoors? *

Yes No

Certified Adults - Outdoor Training

OUTDOOR TRAINING GUIDELINES

Completion of Step 1: Outdoor Video Training for Simple Outdoor Activities and the corresponding questionnaire.

By completing Step 1, volunteers will be allowed to take girls on short hikes and minor outdoor day trips.

Completion of Step 2: Outdoor Manual Training for Long Hikes and Campouts and the corresponding questionnaire.

By completing Step 2, volunteers will be allowed to host backyard sleepovers without cookouts.

Download the
Outdoor Training Manual

Completion of Step 3:
The in-person Outdoor Cookout Training.

By completing Step 3, volunteers will be allowed to take girls camping at primitive campsites and host outdoor cookouts with their troop.

Email Customer Care for help finding training in your area.

To take girls on a hike that is 30 minutes or more from emergency medical services, groups must have an adult with a current Wilderness First Aid Certification or higher/equivalent training.

To take a group backpacking, please email Customer Care for information on how to qualify.

Each stage of the Outdoor Training is current for three years from the date training is completed. Outdoor training can be found at www.gsmw.org/outdoor-training.

Name of GSMW Outdoor-Trained Adult Chaperone (Council policy for all outdoor adventure activities) *
Type(s) of Outdoor Training(s) *
Date Outdoor Training Completed *

Are any adults transporting girls NOT under their legal guardianship? *

Yes No

Transportation Information

Complete a Transportation Form for each vehicle transporting girls. If your group has more than 3 vehicles, please upload a document with the same information that we've asked for below for the additional vehicles. You can upload this on the last page of this form with other documents required for upload.
Date of Trip *
Adult Responsible for Troop *
Troop Number(s) *
Total # of Vehicles *
Trip Destination *
IMPORTANT
In the event of serious injury/accident during business hours, after hours, and weekends, call council headquarters at 1.800.736.5243.

Reminder: Activity Permission/Health History Cards must be in the possession of the driver during all travel to, from and during events/activities.

*If using commercial transportation, please request a pre-signed copy of the rental agreement and upload at the end of this form. If more than one driver is operating the vehicle, complete a Transportation Form for each individual.

Vehicle # 1
Vehicle # 1 Type *

Private car
Vehicle Make / Year / Model *
Vehicle License # *
Driver Name *

First Name Last Name
Driver Phone *
Driver's License # *
Insurance Company *
Policy Number *

Girl Passengers *

Full Name

Girl 1

Girl 2

Girl 3

Girl 4

Girl Passengers

Full Name

Girl 5

Girl 6

Girl 7

Girl 8

Adult Passengers* *

Full Name

Adult 1

Adult 2

Adult 3

Adult 4

*If you have a male chaperone, you MUST also have one unrelated female chaperones.

Vehicle # 2
Vehicle # 2 Type

Private car
Vehicle Make / Year / Model
Vehicle License #
Driver Name

First Name Last Name
Driver Phone
Driver's License #
Insurance Company
Policy Number

Girl Passengers

Full Name

Girl 1

Girl 2

Girl 3

Girl 4

Girl Passengers

Full Name

Girl 5

Girl 6

Girl 7

Girl 8

Adult Passengers*

Full Name

Adult 1

Adult 2

Adult 3

Adult 4

*If you have a male chaperone, you MUST also have one unrelated female chaperones.

Vehicle # 3
Vehicle # 3 Type

Private car
Vehicle Make / Year / Model
Vehicle License #
Driver Name

First Name Last Name
Driver Phone
Driver's License #
Insurance Company
Policy Number

Girl Passengers

Full Name

Girl 1

Girl 2

Girl 3

Girl 4

Girl Passengers

Full Name

Girl 5

Girl 6

Girl 7

Girl 8

Adult Passengers*

Full Name

Adult 1

Adult 2

Adult 3

Adult 4

*If you have a male chaperone, you MUST also have one unrelated female chaperones.

Additional Insurance
Does this trip require additional insurance? See below for details. *

Yes No
Additional insurance is needed if...
- Non-Girl Scouts are attending
- A trip lasting longer than 3 days and 2 nights (for trips occuring during a federal holiday - 4 days and 3 nights are allowed without the additional insurance).
Additional Insurance enrollment MUST be submitted with this troop trip request form (minimum of 14 days before the trip). If needed, please complete the Additional Insurance Form and online payment.

Insurance Levels

Plan 2: Accident Only Insurance (Trips and events less than 2 overnights)
Plan 3E: Secondary Accident & Sickness (Trips and events lasting more than two (2) nights)
Plan 3P: Primary Accident & Sickness (Trips and events lasting more than two (2) nights)
Plan 3PI: Primary Accident & Sickness & Travel Assist (International trips and events lasting more than two (2) nights)

Your Troop Trip is a Council Sponsored program that DOES NOT require notification or approval from council, therefore you do not need to submit a Troop Trip Request Form.

Be sure that all persons participating in the trip are registered for the program prior to your departure.

If you have any questions, please contact us at customercare@gsmw.org.

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Troop Trip & High Risk Activity Request Form

Navigating the Troop Trip & High Risk Activity Request Process

Troop Trip Details

Emergency Contact

Troop Details

Emergency Contact

Activity Details

Activity Budget

Certified Adults - CPR & First Aid

Certified Adults - Activities

Certified Adults - Activities

Certified Adults - Outdoor Training

Certified Adults - Outdoor Training

Transportation Information

Additional Insurance

Document Uploads