Travel Application

Travel Application
Complete this form to request approval prior to any troop/group travel.

Submit at least 4 weeks in advance for local travel

Submit at least 6 months in advance for domestic travel

Submit at least 12 months in advance for international travel

In order to complete this form, you will need the following ready to be attached:
- Participant Roster
- Route Description or Directions (Such as Map Quest)
- Certified Volunteer First Aider Information and Certifications
- Trip Itinerary
Additional insurance is required for travel that is outside of the U.S. territory. Submit the Request for Additional Insurance form at https://form.jotform.com/dakotahorizons/request-for-additional-insurance.
Troop/Group Information
Submission Date*

MonthDayYear
Group/Troop Number*
Service Unit*
Grade Level (Check all that apply)*

DaisyBrownieJuniorCadetteSeniorAmbassador
Group/ Troop Volunteer*

First NameLast Name
Group/ Troop Volunteer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Group/Troop Volunteer Email*
example@example.com
Home Phone Number*

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Attach Participant Roster listing all girls and adults attending the trip; including emergency contact information*

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(The Emergency Contact individual is not attending and will have a copy of the troop itinerary and a roster of all participants, their emergency phone numbers, and Council Emergency Procedures Card)
Number of Registered Girls*
Number of Registered Adult Females*
Number of Registered Adult Males*
Number of Un-Registered Girls*
Fill out additional Insurance Jot Form
Number of Un-Registered Adult Females*
Fill out additional Insurance Jot Form
Number of Un-Registered Adult Males*
Fill out additional Insurance Jot Form
Number of Un-Registered Siblings

Permission, Authorization, and Insurance
What type of trip are you taking?*

Day or up to 2 NightsThree or More NightsInternational Trip
Day Trips and One or Two Night Trips
- Health and Permission Form must be collected and carried on the trip by the Leader/Advisor for each girl participant
- Registered Girl Scouts (girls and adults) and non-registered members are automatically covered by Girl Scout Activity Insurance for trips no matter the length as long as they are within the U.S.
Three or More Night Trips
- Health and Permission Form must be collected and carried on the trip by the Leader/Advisor for each girl participant
- Health and Permission Form must be collected and carried on the trip by the Leader/Advisor for each adult participant
- Additional Insurance is requiredif traveling outside of the U.S. territory
International Trips
- Health History and Medical Examination Form for Adults
- Health History and Medical Examination Form for Minors
- Permission for Minors to Travel
- Authorization for Medical Treatment Adults
- Authorization for Medical Treatment Minors
- Copy of Passport (Attach copy of Passport Below)
- Additional Insurance is required. Fill out additional Insurance JotForm
Copy of Passport*

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Activities
Activities, Tours, and other Destinations planned while on trip*
Trip Itinerary Form*

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How have girls participated in planning this trip?*
Please list activities, outings, and trips completed to prepare for this trip*
Leader/Advisor has reviewed and agrees to follow Volunteer Essentials and the Travel Appendix*

Yes
Leader/Advisor has reviewed and agrees to follow applicable Safety Activity Checkpoints*

Yes
Appropriate girl/adult ratios are met at all times*

Yes
Appropriate and safe equipment will be used at all times in accordance with the Safety Activity Checkpoints, and any swimming will be supervised by a certified lifeguard*

Yes
Location and emergency phone numbers of nearest hospital will be in hand in accordance with Volunteer Essentials*

Yes
A First Aid kit will be brought on the trip*

Yes
Finance
Are volunteers and girls familiar with and willing to follow all council policies on money-earning in Volunteer Essentials?*

YesNo
How will the trip be financed? (Please list in detail)*
Should be Empty:

Travel Application

Troop/Group Information

Travel Plans

Permission, Authorization, and Insurance

Activities

Finance