Girl Scout Council of the Mid-South

Traveling Troop/Camping Approval Request Form

Council approval is required for Girl Scout troops/groups doing activities that include travel farther than 75 miles from regular meeting place and/or overnight travel or camping.

Instructions:

  1. Consult Safety-Wise for the specific and universal checkpoints for basic guidelines and Girl Scout Program Standards to ensure that at all times the health, safety, and security of your group is being practiced. For activities with no checkpoints, you will need to check with your field executive and utilize the �Universal Checkpoint� section in Safety-Wise to determine if the activity is suitable and safe for your group.
  2. Complete the following approval request form and return it to the council three weeks prior to travel.
  3. Obtain written permission forms from a parent or legal guardian before departure.
  4. You will be notified of the status of your request.

* Use the Site Reservation Request Form to reserve council owned/operated facilities.

Fields marked with an asterisk * are required.

GIRL SCOUT TROOP/GROUP INFORMATION

Troop/Group #:* 
Service Unit:  
Troop/Group Age Level:*  D Br Jr Teen Girl Scout 11-17
Name of Troop/Group Leader(s) who have attended Leader Orientation and Age Level Training:* 
Anticipated Number of Participants in this activity:*  Girls      Adults
Leader/Trip Coordinator's First Name:* 
Leader/Trip Coordinator's Last Name:* 
Address:* 
City:* 
State:* 
Zip:* 
Home Phone:* 
Work Phone:  
Cell Phone:  
E-mail:  
Best time and way to be reached:  
  TRAVEL INFORMATION
Date of Travel:*  From To
Destination:* 
Brief description of activity(ies) girls will be engaged in: * 
Mode of Transportation:* 
(All contracts (i.e. rental agreements, etc.) must be signed by the Executive Director/CEO. Please allow a minimum of 72 hours.)

Charter vehicles must have a certificate of insurance on file at the Girl Scout Service Center.

 

Travel Planning and Preparation checklist

We have:

  Reviewed the specific activity checkpoints for this trip or sought advice from our field executive � because the activity  was not listed in the activity checkpoints in Safety-Wise.
  Reviewed the procedures, guidelines, and tips on trip planning in Safety-Wise.
  Made realistic, detailed plans, and budget. Personal and group expenses have been defined.
  Established group conduct expectations and safety precautions and procedures.
  Confirmed the participation of the proper number of adult chaperones who have accepted the responsibilities of this trip.
  For trips of three nights or more, obtained insurance coverage for the entire trip through the council.
  Followed council procedures for getting contracts signed and chartering, renting or borrowing vehicles.  (See Council Guide for Volunteers)
  Provided a copy of the council�s Major Emergency Procedures Card to each adult chaperone.
  Our complete, written itinerary, including telephone numbers and addresses, will be given to the girls, their families, our field executive, and the emergency contact person prior to departure.
 

If camping on an �other than council owned� site, please provide the following information:

Name of Site:  
Address:  
City:  
State:  
Zip:  
Phone:  
Who operates the site?  
Is it licensed by the city/state?     Yes       No
Does the council have insurance information on the site?     Yes       No
Have you visited the site?     Yes       No
If so, please check all that apply:  
  Safe Drinking Water.
  1 toilet/20 campers � with handwashing facilities.
  Separate sleeping accommodations and bathroom available for men if attending.
  No hazardous or potentially dangerous areas nearby.
 
Documentation of Required Certifications:  Note all that apply to your outing.  (See Safety-Wise)
This outing requires a:*     Level I    Level II Certified First Aider 
Our First Aider is:    
First Name:* 
Last Name:* 
Other:  
Please submit copies of documentation to your field executive.
 
Documentation of Trained, Qualified Adult Supervision Camping:
Please check which description best matches your camping plans and note who has attended at least the minimum appropriate training.

  We will be sleeping indoors and using an indoor kitchen (stove/oven) to prepare all of our food. There will be no fire building or outdoor cooking.

  We will be sleeping indoors, but we will be making a campfire and/or cooking some meals outside over an open fire. Minimum Training Option: Group Camping 102. Trained adult:

  We will be sleeping in tents, or using a facility where the sleeping area, kitchen/dining area, and bathrooms are detached, and/or we will be having a campfire or cooking at least some of our meals outside over an open fire. Minimum Training Option: Group Camping 105. Trained adult

If the person teaching and supervising the experience has comparable experience or training, they should submit the Adult Camping Comparable Experience Verification form available at the Girl Scout Service Center.

 

Traveling Troop:

List name and phone # of adult who has attended one of our Girl Scout Traveling Troop training sessions:

First Name:* 
Last Name:* 
Phone:* 
 

Adult Drivers:  Our council requires that adults transporting girls in private or rented cars/vans should be age 21 or older.  They should be properly licensed and carry at least the minimum insurance as required by the state.

If you are chartering, renting, or borrowing vehicles, where the driver is provided; see Council Guide for Volunteers.

If you are depending on parents or other volunteers, using their own or rented vehicles, please provide the following information:

Driver 1 Name (as it appears on driver�s license):  
State of Issue:  
Driver�s License #:  
Name of Auto Insurance Co:  
Driver 2 Name (as it appears on driver�s license):  
State of Issue:  
Driver�s License #:  
Name of Auto Insurance Co:  
Driver 3 Name (as it appears on driver�s license):  
State of Issue:  
Driver�s License #:  
Name of Auto Insurance Co:  

BACK HOME EMERGENCY CONTACT

The following person will know where our troop is during our travel and is the person who should be contacted in case of emergency.
First Name:* 
Last Name:* 
Address:* 
City:* 
State:* 
Zip:* 
Home Phone:* 
Work Phone:  
Cell Phone:  
 
The information provided above is true and as complete as is possible at this time. I understand that I will need to submit any missing required documentation to the council, and that I must obtain written parent permission prior to departure. We have received Leader Orientation and Age Level Training and are taking steps to involve girls in the planning.

We agree that we will strive to meet the program, health, safety and security guidelines as written in Safety-Wise, and abide by Girl Scout policies.
Signature of Girl Scout Leader/Trip Coordinator:*   
Typing your name here qualifies as a valid signature.
Date:* 


                             
You may submit form electronically by clicking submit or print and deliver to the
Girl Scout Council of the Mid-South
Mail: PO Box 240246, Memphis, TN 38124-0246
Deliver: 2715 Kirby Parkway, Suite 1
Fax: (901) 797-2183

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