National & International Troop Travel Planning Summary #121b

National & International Troop Travel Planning Summary

form #121b | 09/23
This is the second part of form 121 for Extended Troop Travel.

Please complete this form three (3) months in advance of your planned trip.
Troop/Group #*
Ex: 12345
Service Unit #*
Ex: 001
Final Destination*
State
Country*
Adult in Charge*

First NameLast Name
Email for Adult in Charge*
example@example.com
Phone Number - Day*
Please enter a valid phone number.
Phone Number - Evening*
Please enter a valid phone number.
Number of Adults Attending*
Ex: 5
Has number of adults attending changed since submitting 121a?*

YesNo
Level of girls at the start of the membership year (beginning October 1):*

CadetteSeniorAmbassador
Level of girls at the time of travel*

CadetteSeniorAmbassador
Number of Girls*
Number of Girls
Trip Details

Departure
Departure Date and Time*

MonthDayYear

Hour MinutesAM/PM Option
Location of Departure*
Type of Transportation*
Name of transporter (include additional information such as American Airlines, Flight 1234)*
Trip Details

Return
Return Date and Time*

MonthDayYear

Hour MinutesAM/PM Option
Type of Transportation*
Name of transporter (include additional information such as American Airlines, Flight 1234)*
Transportation (check all forms that will be used on the trip)*

PlaneTrainBusFerryBicyclePersonal CarOtherRental Car
If Other was selected, please list below.

Vehicle Driver Information: please provide complete information with each application.

	Yes
Each passenger has own seat belt and vehicle is in good working condition.
Verified each driver for proof of insurance.
Verified each driver for current driver's license.

Vehicle Driver Information continued:

	Driver's Name	Vehicle Year/Make/Model	License Plate #	Insurance Company and Policy
1.
2.
3.
4.

Emergency Contact

Person not going on the trip who can be reached by council in an emergency.
Name*

First NameLast Name
Phone Number - Day*
Please enter a valid phone number.
Phone Number - Evening*
Please enter a valid phone number.
Please check each box confirming each item is completed.*

A draft of your travel itinerary must be uploaded with this form that includes dates, addresses and phone numbers of overnight accommodations.Emergency contact person for the troop/group has been provided with an itinerary and contact information for all participants.Additional Girl Scout activity insurance (required only for international travel) will be requested upon receiving final approval of this form.All Safety Activity Checkpoints have been reviewed and will be met on trip.First Aid kits in vehicles or with group.Activity waivers that include hold harmless clauses have been sent to parents/caregivers for signature ahead of the trip. Copies are to be carried with other required paperwork on the trip.

Please print names of adults and girls travelling with the troop/group. Be certain adult contact phone numbers can be reached during the time of travel.*

	Adult	Girl	Participant's First and Last Name	Adult Contact Name	Contact Phone Number(s) Reachable During Trip Dates	Additonal Contact Phone Number if Applicable
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Final Budget

Trip Expenses - Trip expenses should include all attending Girl Scouts and adults.
Admission Fees/person*
Group Total
Type of Lodging*
Lodging Fee/person*
Group Total
Food Cost/person*
Group Total
Insurance Cost/person (only for international travel)
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
Other Expense
Please describe expense
Cost/person
Group Total
10% Emergency Fund
Total Trip Expenses
Final Budget

Trip Funding
Individual Contribution (girls and adults) *
Group Total
Total Troop Contribution (including council product sale profits)*
Total
Total Product Sales Credits*
Total
Other Income
Please describe income
Other Income Amount
Total
Other Income
Please describe income
Other Income Amount
Total
Other Income
Please describe income
Other Income Amount
Total
Total Trip Funding

Itinerary

	Date	Overnight Accommodations (include name, address and phone)	Sights seen/traveled during the day
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Advisor/Leader Statement of Compliance

Troop leader understands and agrees to the following:*

	Initials
GSOSW In-Person Troop/Group Meeting Guidelines, Safety Activity Checkpoints and GSOSW policies and procedures have been reviewed and are being followed.
All adult attendees are approved GSOSW volunteers.
All drivers for these activities are properly licensed and all vehicles are registered, insured, maintained, and have a legal seat and seatbelt for every passenger.
Parents/guardians are informed of the trip activities, safety and emergency procedures, contact information, and have attended a trip meeting to go over participation and behavior agreements.
Parents/guardians have completed all required forms (to be retained by leader during trip): extended trip permission, Girl Health Exam, and any individual activity waivers needed for trip.
The group will always conduct themselves in a positive manner while representing Girl Scouts.
Troop has a record of a cancellation date/policy set for travel plans. Troop understands if they do not have a cancellation policy and/or they do not honor the policy stipulations they run the risk of losing funds payed toward the trip if the trip must be cancelled due to unforeseen circumstances.
All funds raised for travel by members of GSOSW troops are, and shall continue to be, owned by GSOSW for the benefit of the specific troop's use as approved by GSOSW. In no event shall funds raised or donated to an individual volunteer or troop member through GSOSW-affiliated activities, or items purchased with such funds, be considered to be owned by that individual, volunteer or troop member.

Acknowledgment of Responsibilities
I certify that the information on this National & International Troop Travel Planning Summary is correct and current to the best of my knowledge. I understand that troop funds are to be used only for troop members - registered girls and adults required for ratio.

I agree to ensure that during the trip, each vehicle will have health forms for each person, permission forms for each girl, roster of participants, list of emergency contacts, and a first aid kit. I understand providing misinformation could result in the trip not being covered by Girl Scout insurance and could increase personal liability. I acknowledge that GSOSW reserves the right to deny and/or cancel a trip should our plan fall out of compliance with current GSUSA and council safety standards, policies, and procedures. Cancellations may cuase a loss of funds or require the repayment of troop funds.

I understand that I must notify GSOSW of any changes to our submitted plan no less than one (1) month prior to the date of the trip.
Trip Leader Signature*

Clear
Date*

MonthDayYear
Should be Empty:

National & International Troop Travel Planning Summary

Trip Details

Trip Details

Emergency Contact

Final Budget

Final Budget

Advisor/Leader Statement of Compliance

Acknowledgment of Responsibilities