Trip and High-Risk Activity Application
Instructions:
1. Day trips that include a high-risk activity. Submit completed form and any
attachments to info@gsdsw.org at least two weeks prior to trip/activity. Applications
received less than five days prior to the activity will automatically be denied as a Girl
Scout function and troop funds may not be used.
2. Basic Trips (one or two nights). Submit completed form and any attachments to
info@gsdsw.org at least 30 days prior to trip/activity. Applications received less than 15
days prior to the trip or activity will be automatically denied as a Girl Scout function and
troop funds may not be used.
3. Extended Trips (three nights or more). Submit completed form and any attachments
to info@gsdsw.org at least 60 days prior to trip/activity. Applications received less than
30 days prior to the trip or activity will automatically be denied as a Girl Scout function
and troop funds may not be used.
High-Risk Activity List
• Archery
• Axe Throwing
• Backpacking
• Air/BB Guns
• Overnight Camping
• Canoeing
• Challenge Courses
• Climbing and Rappelling
• Offshore Water Vessels (ferries, cruise
ships and airboats)
• Community Clean Up
• Go-Karts
• Horseback Riding
• Indoor Skydiving
• Kayaking
• Knife Throwing
• Row-Boating
• Sail Boarding
• Sailing
• Scuba Diving
• Shooting
• Skiing (downhill) / Snowboarding
• Snorkeling
• Spelunking/Caving
• Stand-up Paddleboarding
• Surfing
• Swimming
• Target Paintball
• Tethered Balloon Rides
• Tubing in Moving Water or Behind a Boat
• Waterskiing / Wakeboarding
• Whitewater Rafting
• Wind Surfing
• Zip Lining
NOT PERMITTED by GSUSA and will not be considered for trip approval.
• Riding all-terrain vehicles (ATVs)
• Bungee Jumping
• Flying in Privately Owned Planes,
Helicopters, or Blimps
• Hang Gliding
• Hot Air Ballooning (untethered)
• Hunting
• Jet Skiing
• Riding a Motorcycle
• Outdoor Trampolines
• Parachuting or Skydiving
• Parasailing
• Paintball Tagging
• Riding Electric Scooters
• Snowmobiling
• Stunt Skiing
• Zorbing
If you have a question about an activity not listed, please contact info@gsdsw.org.
*Camping is defined as any activity in which Girl Scouts sleep overnight in the outdoors or in facilities at an established campground.
**A volunteer is an adult with a council approved Criminal Background Check who is a current registered Girl Scout member.
You may attach separate pages as necessary to this application.
Section 1 Troop Information
Service Unit Troop # Name
Phone # ____ E-mail
Section 2 Trip Information
Departure date & time_______________ Return date & time
Name of destination________________________________________
Address of destination
Name of hotel/overnight accommodations_____________________________________
Address________________________________________________________________
Phone # ________________________Email _________________________________
Per GSUSA:
• Parent/guardian permission must be obtained if girls are to share a bed.
• Male volunteers may participate in Girl Scout overnight trips only when
separate sleeping quarters and bathrooms are available for their use.
• It is not mandatory that an adult sleep in the sleeping area (tent, cabin, or
designated area) with the girls, but if an adult female does share the
sleeping area, there should always be two unrelated adult females
present.
• For overnight trips, list accommodation arrangements below.
Room 1 (2 beds)
Juliette Jones (Junior) & Mary Lopez (Cadette)
Section 3 Activity Information
The troop leader must ensure that vendors satisfy requirements outlined in
Safety Activity Checkpoints for their troop activities.
Activities planned___________________________________________________________
Will this trip include camping? YES NO
Which Safety Activity Checkpoints did you reference for your activities?
____________________________________________________________________________
List any high-risk activities planned __________________________________________
Name of vendor/company/establishment
Website of vendor/company/establishment
Address
Phone Number Email
Section 4 Adults & Training Requirements
Names of adults attending activity/trip with applicable required training.
First Aid & CPR Certification______________ Date completed_________ Exp_______
582 Basic Trips Training __________________ Date completed ___________________
582 Extended Trips Training _______________Date completed ___________________
Outdoor Camp Training ___________________ Date completed ___________________
Section 5 Additional Insurance
Complete the Extra Insurance Enrollment form available at www.gsdsw.org
and attach to this application if your activity/trip includes any of the below:
o Tagalongs (Youth or adults that are not Girl Scout members)
o Is longer than three nights
o International
Children under 5 years are not covered under any additional insurance plan.
Section 6 Participant Roster
All adult volunteers necessary to meet adult/girl ratio must be registered
and have an approved Council background check. ALL adults on an
overnight trip must be registered and have an approved Council
background check.
Make sure names are legible
Registered Girl Scouts and Level
Registered Adults
1.
1.
2.
2.
3.
3.
4. 4.
5. 5.
6.
6.
7.
7.
8.
8.
9.
9.
10.
10.
11.
11.
12.
12.
Tag-a-long Name and age
Adult Tag-a-longs
1.
1.
2.
2.
Emergency Contact Information
2 emergency contacts on the trip
Emergency contact person at home
Name __________ Phone _____________ Name ___________ Phone ____________
Name __________ Phone ______________ Address
You may attach separate pages as necessary to this application.
Section 7 Transportation
All drivers must be properly licensed, registered members and have an
approved Council background check. All vehicles must be registered,
insured, maintained, and have a seatbelt for every passenger.
Girls are transported by parent
___ Carpool/private vehicles (driving unrelated girls)
_____Leased/Rented (national franchise only), rental company________________
Driver Name
Vehicle Make &
Model
License #
Auto
Insurance
Company
Insurance
Expiration
Driver License
# & Expiration
• Girl Scout troops are not allowed to rent 15 passenger vans.
• Do not sign any agreements and/or contracts for bus rental/charters. They
must be approved/signed by CEO or designee. Contact info@gsdsw.org.
Section 8 Trip Budget
Troop funds may only be used for troop girl members and the
minimum required number of adults, as stated in
GSUSA Safety Activity Checkpoints Adult-to-Girl ratio.
Earning to date
Fall product proceeds
$
Cookie product proceeds
$
Dues
$
Money earning projects
$
Other
$
Total budgeted income
$
Trip/activity expenses
Transportation/tickets
$
Lodging
$
Food/meals/tips
$
Tours/admission fees
$
Equipment rental
$
Additional Insurance
$
Other
$
Total budgeted expenses
$
Section 9 Trip Itinerary
Please provide a brief itinerary of your trip.
Date & Time
Location
Activities
Notes
Section 10 Leader Statement of Acknowledgement
Parent Permission forms have been obtained for each girl.
We will keep current Emergency Procedures, Health History Records, and
First Aid Kit on the trip.
We will adhere to GSUSA Safety Activity Checkpoints, GSDSW Volunteer
Policy Manual and GSDSW Volunteer Essentials.
We will conduct ourselves in a positive manner while representing Girl
Scouts of the Desert Southwest and GSUSA.
I understand providing misinformation could result in the trip not being
covered by Girl Scout Activity Insurance and may incur personal financial
responsibility
.
Leader Signature Date