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. Please allow up to 2 weeks for approval.
Troop/Group #
Ex: 12345
Service Unit #
Ex: 001
Final Destination
Start Date of Trip

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date of Trip

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
State
Country
Adult in Charge

First NameLast Name
Phone Number - Day
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number - Evening
Please enter a valid phone number.Format: (000) 000-0000.
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):
Level of Girls at the time of travel
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)

Rows	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.

Rows	Complete	Incomplete	Not Needed	Name	Date
Grade Level
Before You Leave the Meeting Place (replacing Girl Scouts Inside & Out Part 1)
Before Your First Overnight (replacing Girl Scouts Inside & Out Part 2)
Extended Trips
Currently Certified First Aid/CPR
Wilderness First Aid

Rows	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:

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

Rows	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
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Should be Empty:

Troop Travel Notification: National & International Trips

Preliminary Budget

Preliminary Budget