Special Activity Troop Application
Use this form for prior approval to troop travel, if activity involves: overnight, troop camping, high risk or special activities requiring council permission as listed in Safety Check Points. In some cases additional paperwork is needed.
When to submit this form:
4 weeks prior approval
- High-Risk/Sensitive Topics
- Day Trips outside council boundaries
- Overnights stays of 1-2 nights
6 weeks prior approval
- Extended Travel (3 or more nights)
1 year prior approval
- International Trips
This form can not be saved to complete at a later time. Please make sure to have all information ready to complete form and any additional attachment. You will be able to email a copy at the time to submit.
1. Will sensitive Issues will be discussed on this trip?
2. Is this a high risk activity (per safety checkpoints)?
3. Our troop is participating in a:
Overnight stays 1-2 Nights (including camping on non-council sites)
Extended Travel (3 or more nights)
Family Trip (trip includes non-members)
4. Troop #:
5. Service Unit
601 Mojave Blossoms
611 Whispering Pines
612 Desert Squirrel
614 Green Valley
621 Boulder City
632 Painted Desert
635 Centennial Hills
638 Spring Valley
639 Cheyenne Ridge
6. Troop Leader
9. Zip Code
11. Cell Phone #
12. Alternative #
13. Age Level (check the age level)
Expected amount of people attending:
14. # of girls attending
15. # of adults attending
16. # non-member tag-a-longs
17. We are traveling to (name, address, phone number of lodging site):
18. Type of lodging
Non Council Site
19. We are departing to our destination on:
20. We arrive at our destination on:
21. Scheduled return date:
Certifications & Trainings
These training and certifications are needed for any troop overnight travel or special activity.
21. Name of Adult 1
22. Leadership Essentials Completed on
23. First Aid & CPR Training expires on
24. Basic Outdoor training completed on
25. Name of Adult 2 on:
26. Leadership Essentials completed on
27. First Aid & CPR Training Expires on:
28. Basic Outdoor Training Completed on:
If you need to purchase any extra insurance, you can do so on this form. Payment can be made with troop credit card, Visa or Mastercard.
29. Optional Plans
Plan 2, Plan 3E, 3P, or 3PI coverage is needed for events or activities for longer periods and/or to insure person who are not registered Girl Scouts.
PLAN 2: Accident Insurance for Activities or Events Excluded under the Basic Plan
PLAN 3E: Accident and Sickness Insurance for Activities or Events excluded under the Basic Plan
PLAN 3P: Accident and Sickness Insurance for Activities or Events excluded under the Basic Plan
PLAN 3PI: International Travel Plan. Accident and Sickness Insurance for Activities or Events excluded under the Basic Plan.
30. Method of Transportation
10-12 passengers are allowed for transportation, girls must be seated as far forward as possible. The driver must have a Commercial Driver's License.
*Fifteen passenger vans are not approved transportation for Girl Scout activities.
31. Emergency contact at home:
Adult responsible for contacting all parents and council in case of an emergency while the troop is traveling. This adult is not traveling with the troop.
By submitting this form, I will verify all vehicles and drivers are currently registered members and insured according to Girl Scouts of Southern Nevada Nevada's policy as stated in Leadership Essentials training and Activity Safety 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.
Date of submittal:
List of attendees
Please include a list of all attendees (adults, girls, and tag-a-longs) or attach troop roster.
Please fill in the troop travel itinerary or attach a copy of your itinerary.
Please attach a copy of the permission slip that will be provided to the parents.
Instructions for summation:
This form is to be compelled and summited for approval. 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
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