Date:*
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Troop#:*
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Program Level:*
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Service Unit:*
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Troop Leadership:*
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Work Phone:
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Fax:
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Home Phone:*
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Email:*
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Address:*
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City/Zip:*
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Purpose of the trip/overnight:*
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Destination:*
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Date of Departure:*
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Date of Return:*
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Number of Girls:*
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Name, Address and Phone Number of each Adult the accompanying group:*
(Consult page 69 of your Safety Wise for the correct girl/adult
ratio required.)
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Name of Day Tripping & More or Planning Overnight & Trips trained
Adult:*
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Date of Training:*
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Name of Cabin Camping or POT trained Adult:*
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Date of Training:*
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Name of Outdoor I or Troop Camp Training trained Adult:*
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Date of Training:*
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Name of Adult attending trained in first aid/CPR:*
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Card
Expires:*
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If First Aid/CPR was done through an outside source, please send copies of both sides of cards to the Girl Scout Center.
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Name of certified lifeguard (WSI does not qualify)
(if swimming or boating)
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Lifeguard certification must be on file at the Girl Scout Center - if not on file, send a copy to the Girl Scout Center. Check Safety-Wise for lifeguard/girl ratio. In Illinois an adult is consider to be at least 18 years of age.
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Type of Transportation:*
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Other:
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Indicate number needed:*
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If using a bus, a contract must be sent to the Girl Scout Center for required signature.
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Accommodations:*
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Other:
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If using hotel/motel facilities, indicate number of girls per room:
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Sufficient space must be reserved so that each girl has her own bed. Please remember: If using
council-owned tents, they must be reserved. Call the Girl Scout Center to schedule an appointment
to pick them up.
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Are you planning an activity that requires a certificate of insurance?:*
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What is the activity?
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Consult your Volunteer Resource Guide for information on activities that require certificates of insurance. If a certificate of insurance is required and none is on file, you should call the facility to have it faxed to 847-741-5667. If in doubt, call the Girl Scout Center.
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Meeting with parents was held for initial plans for trip on (date):*
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Number
of parents who attended:*
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TRIP ITINERARY*
Include departure and destination schedules, side trips, accommodations,
and rest periods. Please list below. Copy of itinerary must be given
to the troop emergency contact person.
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Troop emergency contact person:*
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Home Phone:*
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Work Phone:*
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Arrangements must be made to obtain the written consent of parents for every girl who wishes to participate. Emergency medical release, annual medical history and medical examination record (if needed) for each girl must be included in the troop first aid kit taken on the trip.
Trips lasting more than three nights are not covered by the Girl Scout Basic Activity Accident Insurance.
You may take out an optional plan of activity insurance through the Girl Scout Center. This plan would
cover the entire period of the event for all participants.
We request permission to travel. We are familiar with the policies and procedures pertaining to
Girl Scout travel and have made our plans accordingly.
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