Girl Scouts Trip Notification Form

Follow all checkpoints listed in the current Safety Activity Checkpoints 2010. When checkpoints and established council notification procedures are followed, you have permission to participate in that activity.

FOR ALL OVERNIGHTS OR TRIPS, of more than 100 miles round trip, submit this form to your service unit manager prior to your trip. For an overnight trip, submit at least seven days prior to your trip. The service unit manager will send required notifications to the council office.

If this is an extended trip (3 or more nights OR 250 miles or more), please complete and submit an Intent to Travel form #893.

Trip Begin Date * / MM / DD YYYY
Trip End Date * / MM / DD YYYY
Type of Trip *
Day Trip (more than 100 miles roundtrip) Overnight Trip
Service Unit *
Troop # *
Age Level *
Number of Girls Attending *
Number of Adults Attending *
Destination/Site *
*
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Location of emergency phone nearest to site *
* - ### - ### ####
Nearest hospital, urgent care, and/or doctor *
- ### - ### ####
Transportation: # of private car(s)
Transportation: # of buses
Other type of transportation used:
Departing from: *
Departure time * : HH MM AM/PM
Return to: *
Return time * : HH MM AM/PM
Name of home emergency contact * First Last
Day Phone * - ### - ### ####
Evening Phone * - ### - ### ####
Planned Activities
CHECK Safety Activity Checkpoints to find out if any of the following are required for your trip. Complete appropriate fields.
First Aider First Last
Phone - ### - ### ####
Date first aid training completed / MM / DD YYYY
Date CPR training completed / MM / DD YYYY
Certified Aquatics Supervisor First Last
Phone - ### - ### ####
Type of Aquatic Certificate
Date Lifeguarding training completed / MM / DD YYYY
Name of certifying agency
Waterfront Module - Year:
Waterfront Module - Number:
Troop Camp Certified Adult First Last
Phone - ### - ### ####
Date of Training / MM / DD YYYY
Name of Leader * First Last
Email *
Day Phone * - ### - ### ####
Evening Phone * - ### - ### ####
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Adult in charge, if other than leader First Last
Phone - ### - ### ####

Girl Scouts Trip Notification Form

Girl Scouts Trip Notification Form

CHECK Safety Activity Checkpoints to find out if any of the following are required for your trip. Complete appropriate fields.