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)
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

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 High Risk Activity List

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
Girl Scout Gift Card Redemption

If you have Girl Scout 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
Girl Scout Gift Card Redemption

If you have Girl Scout 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 ActivityCheckpoints (i.e. lifeguard, certified horseback guide, certified canoe instructor)? *

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

Complete the Outdoor Training Module in gsLearn.

Login to gsLearn and complete the training. The gsLearn training course includes a myriad references and resources you need to plan and implement an outdoor adventure. Volunteers can access the Outdoor Training now in gsLearn! Continue to check the course’s references page to ensure you have the resources you need as your girls progress through outdoor experiences.

Do you have questions about how to access gsLearn? Check out the My Account Tip Sheet: gsLearn for more information.

Complete the gsLearn training every three years.

Complete an In-Person Outdoor Cookout Training every three years.

The Outdoor Training Cookout allows troop volunteers to take girls camping at primitive campsites and host cookouts with their troop.

Check the www.gsmw.org/events page every spring for upcoming training availability and contact your regional MEM or customercare@gsmw.org to request an in-person Outdoor Training for your area. Trainings typically occur in the spring.

To take girls on an outdoor excursion, including hiking, more than 30 minutes from emergency medical services, groups must have an adult with a current wilderness or remote first aid certification or higher training.

To take a troop backpacking, please contact customercare@gsmw.org for information on how to qualify.

Each stage of the Outdoor Training is current for three years from the date training is completed.

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.

Should be Empty:

Troop Trip & High Risk Activity Request Form

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