Fillable Extended Travel Application (Girl Scouts of Oregon and SW Washington)

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Extended Travel Application (Girl Scouts of Oregon and SW Washington)

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This checklist is intended to help organize forms and resources that will need to be completed prior to travel. Please use
this form as a planning checklist as you guide the girls in planning their trip. Underlined forms must be submitted to Girl
Scouts of Oregon and Southwest Washington (GSOSW) for approval.
Extended Travel Application Packet
Extended Travel is approved by submitting the two forms included:
⇨ Extended Trip – Intent to Travel Notification (121a) is to be completed at the beginning of trip planning at least
six months prior to travel.
⇨ Extended Trip – Travel Planning Summary (121b) is to be completed three months prior to travel. Any changes
to this form must be submitted separately no less than one month prior to travel.
Requirements
LJ All participating adults must be registered members of Girl Scouts, have a current and approved background
check on file with the council, and must have completed the initial volunteer trainings (Volunteer Essentials and
Safety).
LJ All GSOSW In-Person Troop/Group Meeting Guidelines, Safety Activity Checkpoints and GSOSW policies and
procedures must be followed.
LJ CPR/First Aid Certification must be obtained by at least one approved adult volunteer going on the trip.
LJ At least one approved adult volunteer going on the trip must have completed all applicable trainings (GS101,
Volunteer Essentials/Safety, Day Trips, Indoor Overnights, Extended Travel Training and Outdoor Skills for trips that
include camping).
Girl Information (per attending girl)
LJ Participation agreement and/or behavior agreement
LJ Extended Travel Permission Slip
LJ Girl Health Exam Form
LJ GSOSW Assumption of Risk, Release and Waiver of Liability Relating to CORONAVIRUS/COVID-19
LJ Any waivers/releases for activities on trip (to be signed by parent/guardian)
Adult Information (per attending adult)
LJ Participation agreement and/or behavior agreement
LJ Adult Health Exam form
LJ Copies of Driver’s License and Insurance card for all drivers
LJ GSOSW Assumption of Risk, Release and Waiver of Liability Relating to CORONAVIRUS/COVID-19
LJ Any waivers/releases for activities on trip
Insurance
LJ For Extended Travel Insurance, email insurance@girlscoutsosw.org with trip location, dates and number of
participants.
LJ It is recommended that troops purchase the trip insurance offered through lodging or transportation vendors. Be
sure to read through the policy to make sure it covers pandemic and other appropriate reasons for cancellation.
Cookie/Nut Credits
LJ If girls plan to transfer Cookie/Nut Credits to the troop for the trip or use their adventure pass, submit the Cookie/Nut
Credit Transfer Request (form #238) at least four weeks prior to when funds are needed. You must have approved
travel paperwork on file with the council before funds will be transferred.
Extended Travel Application
For any trip of more than three nights or more than 200 miles out of council
borders. Application must be submitted to travel@girlscoutsosw.org
Extended Trip - Intent to Travel Notification
form #121a • 03/21 • page 1 of 2
This form is required for any trip of more than three nights or more than 200 miles out of
council borders. Submit completed form by email to travel@girlscoutsosw.org or fax to
541-857-8525 at least six months in advance of your planned trip. Please retain a copy of your
form and approval.
Due to COVID-19 continuing to present significant health and safety challenges across our council, troops may not
travel before June 1, 2021. Only paperwork with trip dates after June 1 will be considered for approval.
Troop/Group # ______________Service Unit # __________Dates of Trip: From ________________To _______________
Adult in Charge ___________________________________ Phone: Day _________________ Evening ________________
Mailing Address ____________________________________ City ________________________ State _____ ZIP _______
Email Address ______________________________________________________________________________________
Other Adult Chaperones (all must go through the Volunteer Application Process): ________________________________
__________________________________________________________________________________________________
Level of girls at the start of current membership year (beginning October 1): JR CAD SR AMB
Adult/girl ratio verified: # of girls ______________ # of adults _______________
If you are bringing adults beyond safety ratio, please explain: ________________________________________________
__________________________________________________________________________________________________
Final Destination __________________________________________ State _________ Country ___________________
Please indicate all of the following that apply:
Primitive camping (NO water, toilets or electricity) Camping in established campground
Backpacking Hostels, community buildings, hotels
Personal home/cabin Vacation rental (privately or commercially owned)
What other overnight trips has the troop/group taken to prepare for this trip?
Date Location Length of Trip
I understand all of the following requirements must be met at least six weeks prior to the scheduled departure
date for this trip:
C I NN
(C = completed, I = in progress, NN = not needed)
“Grade Level” Name Date (mm/dd/yy)
“Day Trips” Name Date (mm/dd/yy)
“Indoor Overnights” Name Date (mm/dd/yy)
“Extended Trips” Name Date (mm/dd/yy)
Currently Certified First Aid/CPR Name Expires (mm/dd/yy)
“Wilderness First Aid” Name Expires (mm/dd/yy)
“Outdoor I” (camping at established campgrounds) Name
“Outdoor II” (camping at primitive campgrounds) Name
Lifeguard Certification - For all water
activities offered including use of
hotel swimming pools
Name Expires (mm/dd/yy)
Small Craft Safety Certification Expires (mm/dd/yy)
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.
FOR OFFICE USE ONLY Date Received __________________________________ Paperwork Review Date ________________________
Reviewed & confirmed chaperones VAP approval ________________________ Updated travel database ____________________________
Initial Approval? ___________________________ Conditional? ______________________________ Denied? ___________________________
Reason ______________________________________________________________________________________________________________
Leader Notified ______________________ By ____________________________________________________ Date _____________________
Extended Trip - Intent to Travel Notification
form #121a • 03/21 • page 2 of 2
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)?
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Preliminary Budget
Any special circumstances that affect the budget? ________________________________________________________
No purchase or reservations towards 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
and Safety Activity Checkpoints in regards to extended trips.
Signature of Adult in Charge _____________________________________________________ Date __________________
Submit completed forms by email to travel@girlscoutsosw.org or by fax to 541-857-8525.
Trip Expenses
Per Person Total
Admission Fees
Lodging/Site Fees - Type of lodging:
Food
Insurance
Transportation Costs - Type of transportation:
Other Expense - Describe:
Other Expense - Describe:
Subtotal
Add 10% Emergency Fund
Total Projected Expenses
Trip Funding
Per Person Total
Girl Contribution (Family Portion)
Troop Contribution - At start of trip planning:
Troop Money Earning - Troop goal:
Product Sales Credits
Other Income - Describe:
Total Projected Income
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Extended Travel Application (Girl Scouts of Oregon and SW Washington)

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Completed 2 July 2021

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