Van Interest Form

GSNYPENN Van Usage Request Form

Want to drive the van in a parade or event? Let us know!
Before You Begin:

Please note - as part of the van request process, the driver is required to provide a copy of a valid Driver's License (front and back) and current Driver's Abstract (aka copy of your driving record). Please gather these documents before proceeding.

To obtain your Driver's Abstract, follow the links below:
- New York State - Use the Records Request Navigator and follow the prompts. As of 10.26.2023, NYS charges $10.00 for a Driver's Abstract
- Pennsylvania - Use the Individual Drivers Record and follow the prompts. As of 10.26.2023, PA charges $14.00 for individual driver's records.
Your Driver's Abstract is considered current for one year. Please save a copy for your files so that you have it for any other van requests you may make within the next year.

We will only allow registered adult Girl Scouts in good standing, with a valid driver's license, satisfactory driver's abstract, and satisfactory criminal background check to use council vehicles. Again, all requests are subject to approval.
Event Name
Event Description
Event Date and Time

MonthDayYear
Hour MinutesAM/PM Option
Event Location
Event Starting Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Who will be driving the van?

SelfAnother Adult Girl Scout
Reminders:

The driver is required to provide the following documentation to GSNYPENN prior to driving the van:
- Copy of valid Driver's Licence (front and back)
- Current Driver's Abstract (all pages)
To obtain a copy of your Driver's Abstract (aka copy of your driving record), please follow the instructions at the top of this form.

We will only allow registered adult Girl Scouts in good standing, with a valid driver's license, satisfactory driver's abstract, and satisfactory criminal background check to use council vehicles. Again, all requests are subject to approval.

Please upload your documentation in the Supporting Documents field below.
Supporting Documents

Attach documents here.
Cancelof
Training

All drivers must view the 169 GSNYPENN Van Rental video and complete the Acknowledgement a minimum of 2-weeks prior to using the van for the first time.
Type of Event

ParadeCommunity PartyFood driveOther
Preferred Pickup Location

HorseheadsSyracuse
Entity Sponsoring the Event
Contact Person

First NameLast Name
Contact Person Phone
Please enter a valid phone number.
Contact Person Email
example@example.com
Entity Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Acknowledgment
I/We understand that approval is needed in order to use the council van. Until my request is confirmed it is not guaranteed; I will be contacted about my request within 2-4 business days.

I/We understand that we need to provide a current copy of both our driver's abstract and our valid driver's license. Further, we are responsible for any fees associated with obtaining this documentation.

I/We will only transport individuals who are participants in the above-mentioned Girl Scout event(s). Further, I understand that only 12 people, including the driver, may ride in the van and only one person is allowed per seat/seatbelt.

I/We are responsible for following all Girl Scout Safety Checkpoints along the GSUSA and GSNYPENN policies and procedures during this event and travel to/from the event.
Volunteer Name

First NameLast Name
Volunteer Signature

Clear
Date Signed

MonthDayYear
Should be Empty:

GSNYPENN Van Usage Request Form

Acknowledgment