Overnight/Travel Activity Form

This form can't be saved to complete at a later time. Please make sure to have all information ready to complete this form and any additional attachments needed. You will be able to email a copy to yourself at the time you submit.

Our troop is participating in a:*

Please mark all that apply to this travel request.

Select or enter value

Troop #:*

Service Unit

Select

Troop Leader*

Email*

Cell Phone #*

Alternative #*

Age Level (check the age level)*

Multi-level troops, please check all that apply.

Select

# of girls attending*

# of adults attending*

Please note, adults participating in overnights must have a membership and valid background check.

GSUSA encourages an all-girl atmosphere for sleeping quarters. Men may participate only when separate sleeping quarters and bathrooms are available for their use. When family camping members of the same family may share a tent.

# non-member tag-a-longs*

We are traveling to (name, address, phone number of lodging site):*

Type of lodging*

Council site

Non Council Site

Hotel/Motel

Other

We are departing to our destination on:*

We arrive at our destination on:*

Scheduled return date:*

Weather Check*

Please confirm that you've checked or will check weather forecast and have appropriate gear for expected weather.

Certifications & Trainings

Trainings and certifications are needed for any troop overnight travel or special activity. At least two registered and background checked members are required. Additional chaperones may be needed, check girl to adult ratios in Volunteer Essentials.

At least one adult must have taken Girl Scouts on the Go or Troop Trip Training.

Outdoor Basics Overnight Training is required if the trip involves outdoor activities including but not limited to: campfires, outdoor cooking, hiking or tent camping.

At least one adult must be CPR/First Aid certified, who will be present for the duration of the trip. CPR/First Aid must be on file with GSSNV.

Plan Ahead! Per GSUSA Safety Activity Checkpoints, many outdoor and water activities require special instructors to be present and/or an adult with American Red Cross Basic Water Rescue certification to be present. Check SAC and include how you will fulfill safety requirements with your submission.

Name of Adult 1*

Volunteer Essentials/Volunteer Orientation completed?*

Required for one volunteer.

Yes

No

Unsure

First Aid & CPR certified?*

Required for one volunteer who will always be present with girls in attendance.

Yes

No

Unsure

Girl Scouts on the Go/Troop Trips training completed*

Required for one volunteer.

Yes

No

Unsure

Outdoor Basics training completed*

Outdoor Basics Overnight Training is required for one volunteer if the trip involves outdoor activities including but not limited to: campfires, outdoor cooking, hiking or tent camping.

Yes

No

Unsure

Name of Adult 2:*

Volunteer Essentials/Volunteer Orientation completed?*

Yes

No

Unsure

CPR & First Aid certified?*

Yes

No

Unsure

Girl Scouts on the Go/Troop Trips training completed?*

Yes

No

Unsure

Outdoor Basics training completed?*

Outdoor Basics Overnight Training is required if the trip involves outdoor activities including but not limited to: campfires, outdoor cooking, hiking or tent camping.

Yes

No

Unsure

Additional Insurance

You may need to purchase extra insurance, Please indicate what is needed.

Additional Insurance Plans

Plan 2, Plan 3E, 3P, or 3PI coverage is needed for events or activities for longer periods and/or to insure persons who are not registered Girl Scouts and are active participants.

Those who are not active participants and/or are not the appropriate age level to participate in activities would not be covered by the additional Girl Scouts Insurance purchase.

Please refer to the Mutual of Omaha Girl Scout insurance website for further details https://www.mutualofomaha.com/girl_scouts_of_the_usa/

PLAN 2: Needed for non-members who are participating in the activity

PLAN 3E: Needed for all active participants if the activity is longer than 2 nights (3 nights if over a holiday weekend) in duration.

PLAN 3P: Needed for all active participants if activity is longer than 2 nights (3 if over a holiday weekend) in duration and there are active participants without primary insurance

PLAN 3PI: International Travel Plan. Accident and Sickness Insurance for Activities or Events excluded under the Basic Plan.

I've read through the Mutual of Omaha website and have determined that I don't need to purchase additional insurance.

I've read through the Mutual of Omaha website and need help determining if I need insurance.

Method of Transportation*

10-12 passengers are allowed for transportation, girls must be seated as far forward as possible. Fifteen passenger have unique requirements, review Safety Activity Checkpoints to ensure compliance.

Private Vehicle

Leased Vehicle

Commercial Plane

other

Emergency contact at home:

Adult responsible for contacting all parents and council in case of an emergency while the troop is traveling.

This adult would not be traveling with the troop.

Name*

Cell Phone*

Leader Signature

By submitting this form, I will verify all vehicles and drivers are currently registered members and insured according to Girl Scouts of Southern Nevada's policy as stated in Leadership Essentials training and Safety Activity Check Points. I will assure the number of passengers does not exceed the number of seat belts available. I have read all appropriate standards in Safety Check Points and the council policies and agree to adhere to them.

Leaders Name*

Date of submittal:*

List of attendees*

Please include a list of all attendees (adults, girls, and tag-a-longs).

Itinerary (required)*

Please fill in the troop travel itinerary or attach a copy of your itinerary. If attaching at the bottom of this form, please enter "attached".

Educational Component/Community Service

Girl Scout Programming Component*

Please tell us about Girl Scout programming and/or community service your troop is participating in during the trip.

Attachments*

Please attach a copy of the filled out permission slip that you will provide to caregivers prior to the trip. Fill out the top portion of the permission slip and attach here. Please do not attach a blank form.

Drag and drop files here or

Instructions for summation:

This form should be completed and submitted for approval prior to making final plans. Please check for accuracy! Misinformation could result in Girl Scout Activity Insurance coverage not being valid for this trip and/or increased personal liability.

Send me a copy of my responses