Extended Travel/High Risk Application For troop or groups planning Extended/International travel and/or High Risk Activities Trip Information arrowup6 Application Date * Type of Application * Preliminary (required for all travel overnights) Revised (as needed) Definition of Activity Types Extended Domestic Travel is greater than 3 nights High Risk Activity as defined by Volunteer Essentials Use the Drop Down to select the type of activities Type of Activities * Indoor Camping Extended Domestic Travel International Travel High Risk High Risk - No Overnight Select all activities that apply to this trip Number of Nights * 1 - 2 nights 3 - 9 nights 10+ nights Describe High Risk Activity * Activity/Travel Start Date * Activity/Travel End Date * Location/Destination * Enter the Location and/or Destination Location Address * Enter the Street Address, City, State and Zip Code. Location Phone * Type of Lodging * Girl Scout Program Center or Property Campground Hotel/Motel/Hostel/Time Share/Other Rental Private Home Private Rental - Airbnb Private Rental - HomeAway Private Rental - Vrbo Cruise Ship Other (Explain below) Select all types of lodging that that apply to this trip. Other Type of Lodging * Examples of "Other" can be (Museum, Organized Camp, Tall Ship etc...) Group Information arrowup6 Type of Group * Troop Group Region * North Southeast Southwest Service Unit Name * Please select the Service Unit that the Group Leader is from Troop Number or Group Name Please enter either your Troop Number if this is a troop event or your Specialty Group Name. Please don't enter your troop name if you have one. Girl Scout Level(s) * Daisy Brownie Junior Cadette Senior Ambassador Click all that apply. Adult in Charge of Trip * Enter the name of the adult in charge of the trip or overnight. Adult's Address * Include street, city, state and zip code Adult's Home Phone Number * Adult's Cell Phone Number * Adult's Email Address * Leader Information arrowup6 Is the Adult in Charge of Trip the Troop Leader * Yes No Leader's Name * Phone Number * Email Address * Overnight/Trip Details arrowup6 Girl Planning * How did the girls partipate in the planning of this trip? Preparation * What preparation have the girls had for this trip? What type of activities are planned? * Mode of Transportation * Car Train Boat Airplane Bus Van (1-12 Passenger) Public Transportation Rental (car or van) Other Check all that apply to the trip. Review Volunteer Essentials for requirements of each mode of transportation. Note: 15 passenger vans are not allowed. Further Explanation * Please explain "Other" Mode of Transportation Will a vehicle be driven by an adult with more than 9 passengers? * Yes No Commercial License * Drop a file here or click to upload Choose File Maximum file size: 52.43MB Commercial License is required for driving more 9 passengers. Please upload a copy of your Commercial License. Note: 15 passenger vans are not permitted for Travel with girls. Offsite Emergency Contact * Please enter name of person who can be contacted in an Emergency. Phone Number of Emergency Contact * if more than one, enter details in comments at bottom of form. Number of Girls Participating * Number of Adults Participating * Total Number of Participants Roster of all Participants and Driver List * Drop a file here or click to upload Choose File Maximum file size: 52.43MB Please upload a of list names of all attending girls and adults with cell numbers. Please identify the drivers. According to GSGLA Adult Volunteer Practices and Procedures under Vehicle Drivers, Leaders can ask for proof of valid license, current liability information and current vehicle registration for driver. File can be a .doc, .docx, .pdf, .xls, .xlsx, .jpg and .csv I confirm that all adults have met Girl Scout Requirements to be on this Trip. * Yes No Confirmation that all adults have met the requirements stated in Volunteer Essentials. (Regarding registered GIrl Scout Adults, volunteer application and criminal background check) Additional Trip Insurance * Yes No Basic insurance through your Girl Scout membership fee covers registered Girl Scouts for 2 nights. If your trip is longer than 2 nights, have you purchased extended activity insurance? Non-Member Insurance * Yes No Non-Member insurance is required for any participant that is not a registered Girl Scout. Adult Training Certifications/Qualifications arrowup6 First Aider Name * Phone Number of First Aider * Email Address of First Aider Type of Certification (check all that apply) * FA/CPR/AED Wilderness and Remote Healthcare Professional FA/CPR/AED Certification Expiration * Wilderness and Remote Certification Expiration * Professional Healthcare Title * Please enter professional title of the First Aider. Please make sure they are certified to handle emergency first aid. Indoor Overnight Trained Adult * Indoor Overnight Training Completion Date * Domestic Troop Travel Trained Adult * Domestic Troop Travel Training Completion Date * International Travel Trained Adult * International Travel Training Completion Date * Camping Skills Trained Adult * Camping Skills Training Completion Date * Will this trip include any water activities? Yes No Who will be overseeing the water activities? (Check all that apply) * Certified Lifeguard (provided by site) Certified Lifeguard (not provided by site) Certified Swim Watcher Certified Lifeguard Name (not provided by the site) * Lifeguard Certification Date * Certified Swim Watcher Name * Swim Watching Certification Date * Will this trip include any backpacking activities? * Yes No Backpacking Trained Adult * Backpacking Training Completion Date * Would you like to list any additional adults with specialty training? * Yes No Type of Training * Trained Adult * Training Completion Date * Applicable Forms arrowup6 Itinerary * Drop a file here or click to upload Choose File Maximum file size: 52.43MB Upload a copy of the trip itinerary. File can be a .doc, .docx, .pdf, .xls, .xlsx, .jpg and .csv Detailed Trip Budget * Drop a file here or click to upload Choose File Maximum file size: 52.43MB Expenses include: transportation, lodging, meals, program cost, insurance, emergency funds. Income includes: Product sales, troop/group dues, individual Girls/Adults, and extra money earning activities and sponsorships. File can be a .doc, .docx, .pdf, .xls, .xlsx, .jpg and .csv Back Up Plan * What alternative plan does the troop/group have should this trip not take place? Submission Name * Name of person submitting this application Submitter's Email * Contact information if problem with this application. Agreement Statement * Yes By submitting this form, I agree that the above and below statements are true, that I have read and agree to adhere to the GSUSA and GSGLA policies regarding troop travel and overnight activities and safety as stated in Volunteer Essentials and GSUSA Safety Guidelines, and this application. I have reviewed the Policies concerning troop travel and overnights and agree to adhere to them. I have reviewed this form and understand my (our) responsibilities. I am aware that Girl Scouts must be supervised by two registered female adult at all times. Submitter Comments Print application before submittal, in case the server goes down. If you are experiencing problems in getting your application submitted and you are using Internet Explorer as your browser please switch over to Chrome., Firefox or Safari. If you continue to have problems please try later in the day. Sometimes we have been experiencing problems with the server. These are temporary. You should receive a confirmation email in 5 to 10 minutes. Thank You reCAPTCHA Event Status Approval PendingSU ApprovedGo Team ApprovedCouncil Approved If you are human, leave this field blank.
