Regional Troop Travel Notification form 119

Regional Troop Travel Notification

form #119 | 9/24
Complete this form to notify the council of regional overnight troop travel or high risk day trip AFTER completing regional travel qualification with your service unit Girl Experience Mentor or GEM. If your troop has not completed travel qualification, do not submit this form and connect with your GEM or email answers@girlscoutsosw.org if you do not have one in your area. Please note: this form is for troop/group travel only and not required for Juliettes.

Regional Travel is defined as travel within 6 hours drive of the troop meeting place. Trips of 4 or more nights require Extended Travel Training.

Please complete this form two (2) weeks in advance of your planned trip.
Service Unit #*
Ex: 001
Troop/Group #*
Ex: 12345
Adult in Charge*

First NameLast Name
Email for Adult in Charge*
example@example.com
Phone Number - Evening*
Please enter a valid phone number.
Phone Number - Day*
Please enter a valid phone number.
Type of regional trip*
Select trip type from the drop down list
Final Destination*
Location of travel
Street Address of Destination*
No more than 200 miles outside council borders
State*
Activities Planned*
List activities planned during trip
Departure Date and Time*

MonthDayYear

Hour MinutesAM/PM Option
Return Date and Time*

MonthDayYear

Hour MinutesAM/PM Option
Number of Girls Attending*
Number of Girls
Number of Adults Attending*
Ex: 5
Level of girls at the start of the membership year (beginning October 1):*

DaisyCadetteBrownieSeniorJuniorAmbassador
Troop Roster

Enter the names of girls and adults traveling with the troop/group below OR attach a copy of the troop roster if the whole troop is traveling.

Submit names of all adults and girls travelling with the troop/group.

	Adult	Girl	Participant's First and Last Name
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

If you have additional participants please email the full roster to answers@girlscoutsosw.org and include "119 update" in the subject line.
Transportation (check all forms that will be used on the trip)*

PlaneTrainBusFerryRental CarPersonal CarOther
If Other was selected, please list below.
Vehicle driver information

Complete this section if you are using a personal or rental car for every adult volunteer who will be driving.

Vehicle Driver Information: if personal or rental vehicle is being used please provide complete information.

	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.
5.
6.
7.
8.

If you have additional drivers please email a list to answers@girlscoutsosw.org and include "119 update" in the subject line.
Emergency Contact

Person not going on the trip who can be reached by council in an emergency. This person will be given a copy of the trip itinerary, roster, carpool list and health forms of who is attending. They understand they are responsible for knowing the whereabouts of the group at all times.
Name*

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

Trip Expenses - Trip expenses should include all attending Girl Scouts and adults.
Troop/Group Funds Contributed*
What is the total amount of troop/group funds going towards the trip?
Family/Girl Contribution*
What is the total amount that girls/families contributed towards the cost of the trip?
Product Program Credits transferred*
What is the total amount of product program credits transferred for this trip?
Expected Cost per person*
How much will the trip to cost per person?
Total Trip Expense
Advisor/Leader Statement of Compliance

Troop leader understands and agrees to the following:*

	Initials
GSOSW In-Person Troop/Group Meeting Guidelines, Safety Activity Checkpoints, GSOSW policies and procedures have been reviewed and are being followed.
Regional Travel Qualification has been completed prior to this notification. Therefore, all adult attendees have a current membership, a completed background check, GSOSW Foundations online training and GSOSW Mandatory Reporter online training. At least one adult has all the required trainings needed for this trip.
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. Each vehicle has a first aid kit.
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): permission form and up-to-date health history form and any individual activity waivers needed for trip. A signed permission form with health history is given to each driver and emergency contact.
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 form 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 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 cause a loss of funds or require the repayment of troop funds.

I understand that I must email answers@girlscoutsosw.org of any changes to our submitted plan no less than three (3) days prior to the date of the trip.
Trip Leader Signature*

Clear
Date*

MonthDayYear
Should be Empty:

Regional Troop Travel Notification

Troop Roster

Vehicle driver information

Emergency Contact

Final Budget

Advisor/Leader Statement of Compliance

Acknowledgment of Responsibilities