National & International Troop Travel Notification #121a

Troop Travel Notification: National & International Trips

form #121a | 09/24
This form is required for any trip that is more than 6 hours drive from the troop meeting place and outside GSOSW council borders, no matter the duration of the trip. Complete this form at least six (6) months in advance of your planned trip.
Troop/Group #*
Ex: 12345
Service Unit #*
Ex: 001
Final Destination*
Start Date of Trip*

MonthDayYear
Date
End Date of Trip*

MonthDayYear
Date
State
Country*
Adult in Charge*

First NameLast Name
Phone Number - Day*
Please enter a valid phone number.
Phone Number - Evening*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Level of Girls at the start of the current membership year (beginning October 1):*

JuniorCadetteSeniorAmbassador
Level of Girls at the time of travel*

CadetteSeniorAmbassador
Number of Girls *
Number of Girls
Number of Adults*
Number of Adults
If you are bringing adults beyond safety ratio, please explain.*

Other Adult Chaperones (all must go through the Volunteer Application Process)*

	First Name	Last Name
1.
2.
3.
4.
5.

I understand all of the following requirements must be met at least six weeks prior to the scheduled departure date for this trip.*

	Complete	Incomplete	Not Needed	Name	Date
Grade Level
Girl Scouts Inside & Out Part 1
Girl Scouts Inside & Out Part 2 (replacing Day Trips and Indoor Overnights)
Extended Trips
Currently Certified First Aid/CPR
Wilderness First Aid

	Complete	Incomplete	Not Needed	Name	Expiration Date
Lifeguard Certification - for all water activities offered including use of hotel pool
Small Craft Safety Certification
Outdoor I (camping at established campgrounds)

Please email answers@girlscoutsosw.org a copy of any new certifications you have listed above (CPR, Wilderness First Aid or Lifeguard) if you did not take them through GSOSW.
Lodging - Please select all that apply:*

Primitive Camping (NO water, toilets or electricity)BackpackingPersonal home/cabinCamping in an established campgroundHostels, community buildings, hotelsVacation rental (privately or commercially owned)

What other overnight trips has the troop taken to prepare for this trip? Please list all applicable trips.*

	Date	Location	Length of Trip
1.
2.
3.
4.
5.

What are the girls doing to plan/prepare for this trip?*
How will the Girl Scout Leadership Experience be incorporated into their trip (girl-led, learning by doing, cooperative learning)?*
We understand these amounts are estimates only. Make your best guess. You should revisit this budget as final trip plans are formalized. Add an additional page for budget items.
Preliminary Budget

Trip Expenses - Trip expenses should include all attending Girl Scouts and adults. We understand these amounts are estimates.
Admission Fees/person*
Group Total
Type of Lodging*
Lodging Fee/person*
Group Total
Food Cost/person*
Group Total
Insurance Cost/person (for international travel only)
Group Total
Type of Transportation*
Cost/person*
Group Total
Other Expense
Please describe expense
Cost/person
Group Total
Other Expense
Please describe expense
Cost/person
Group Total
Total Trip Expenses
Preliminary Budget

Trip Funding - We understand these amounts are estimates.
Individual Contribution (girls and adults)*
Group Total
Total Troop Contribution - at start of trip planning including council product sale troop profits*
Total
Total Troop Money Earning - Troop goal*
Total
Total Product Sales Credits*
Total
Other Income
Please describe income
Other Income Amount
Total
Total Trip Funding
Any special circumstances that affect the troop?*
No purchase or reservations toward this trip will be made prior to receiving approval of this form (#121a).

I hereby verify that the above information is correct and that I will follow all council policies, standards and procedures adn Safety Activity Checkpoints in regard to extended trips.
Signature of Adult in Charge

Clear
Date

MonthDayYear
Should be Empty:

Troop Travel Notification: National & International Trips

Preliminary Budget

Preliminary Budget