GSNENY Troop or Group Intent to Travel Form
Service Unit #
Service Unit Manager (if you are a troop leader)
Service Unit manager's email
If you selected mutli level above, what is the youngest level of Girl Scout in your troop or group?
Please enter a valid phone number.
Start Date/Time of Trip:
End Date/Time of Trip:
Brief Trip Description (service. learning, adventure):
How are the girls involved in planning for this trip?
How have the girls prepared for this trip?
How many adults will attend this trip?
How many girls will attend this trip?
Adult Participants (please separate each name with a comma)
Which leaders have CPR and First Aid Training?
Girl Participants (please separate each name with a comma)
Name(s) of company or airline:
Drivers (include drivers license numbers)
Trip Emergency Contacts and Phone Numbers
How does the trip relate to the Girl Scout Leadership Experience?
Day to Day Itinerary
Advisor/Leader Statement of Compliance
GSUSA Safety Activitity Checkpoints, GSUSA and GSNENY health, safety and insurance, emergency procedures have been reviewed and are adhered to as defined in Volunteer Essentials, the GSUSA Travel Appendix, and the GSNENY Troop or Group Travel Guidelines.
All drivers for these activities (who are driving Girls not their own) are properly licensed and all vehicles are registered, insured, maintained and have a seat and seatbelt for every passenger.
Parents and guardians are informed of the trip activities, safety and emergency procedures, and contct information.
Appropriate permissions have been obtained for each girl including health forms.
Our troop or group will conduct ourselves at all times in a positive manner while representing Girl Scouts.
I understand providing incorrect informationm could result in the trip not being covered by Girl Scout Activity Insurance and could increase personal liability.
Girl Representative Signature
Should be Empty: