High Risk Activity Form

High Risk Activity Form

This form should be used when troops, groups, or individual Girl Scouts are participating in a High Risk Activity as listed in Safety Activity Checkpoints(SAC). Please follow all safety guidelines as listed in Safety Activity Checkpoints, Volunteer Essentials and by the host of the activity. This form should be submitted at least 4 weeks prior to the activity.

First Name of Adult Contact*

Last Name of Adult Contact*

Troop, Service Unit Number or Committee*

What Is The High Risk Activity?*

Name of certified trainer, company or agency conducting or sponsoring the activity*

Ensure agency or person fulfills requirements as stated in Safety Activity Checkpoints

Date of Activity*

Levels Of Girl Scouts Participating In Activity*

Were Safety Activity Checkpoints Reviewed??*

Please Indicate that participating leaders have read the appropriate Safety Activity Checkpoints.

Are Special Certifications Needed and Fulfilled?*

Please indicate any special certifications or training needed for this activity as indicated in Safety Activity Checkpoints.

SAC Must be Reviewed With Girls And Parents*

Please indicate that you will review the appropriate Safety Activity Checkpoints with your troop families.

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