EmailMe Form - Troop Activity Approval Application

Girl Scout Volunteer in charge of activity: *
First Last
Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone: *
### - ### - ####
Email Address: *

(please re-enter email to confirm)
Troop Number: *
Troop Level:
Daisy
Brownie
Junior
Cadette
Senior
Ambassador
Daisy Scouts can participate in activities allowed by GSUSA Safety Activity Checkpoints.
Service Unit: *
If "OTHER" Please explain below:
Name of Certified First Aid Provider: *
Certifying Agency: *
Level of Certification: *
Level 1
Level 2
Expiration Date on Card: *
MM / DD / YYYY
Event Information: Please provide information on when and where your event will take place.
Anticipated dates of activity: *
Company OR Private Instructor Name *
Contact Person: *
The name of the person at the the company you are having your event
Email Address: *
email address of the contact person at the event
Phone: *
### - ### - ####
Address/Location of Activity: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Please check all activities that apply: *
Archery
Backpacking
Boating
Canoeing
Caving
Challenge Courses
Fishing with Vendor
Go Carts
Horseback Riding
Kayaking
Knife Throwing, Tomahawk Throwing
Rappelling
Rock Climbing
Sailing
Scuba Diving
Segway
Skiing
Snowboarding
Surfing
Water Skiing
White River Rafting
Ziplining
Other (please specify):
Check all that apply: *
I have read and will adhere to all guidelines in Girl Scout Safety Activity Checkpoints, Volunteer Essentials and Policies and Standards
I have current Health History and Permission Slip forms for all Girl Scouts in troop/group.
All Girl Scouts in troop/group are prepared for this activity both physically and mentally
I have given a Safety Briefing to all attending Responsible Adults
All Girl Scouts participating in activity are current GSOC members
Safety Activity Checkpoints

Approved High Risk Activity Vendors
Signature: *
Clear
By submitting this form, I confirm that the information in this form is correct to the best of my knowledge.
File Upload

Event Information: Please provide information on when and where your event will take place.