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This form obtains parent/caregiver permission for all troop (Girl Scouts of Greater Los Angeles)

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rlscoutsla.org
Emergency: (877) 423-4752
This form obtains parent/caregiver permission for all troop meetings, events, and activities for the Girl Scout
year, excluding extended-day trips (8+ hours), overnights, and/or high-risk activity as defined by Safety
Activity Checkpoints. Troop leaders agree to inform parents and the service unit manager, in print or
electronically, when an activity is away from the normal meeting site(s). With the use of this form, additional
permission forms are not required for troop events or activities, unless requested by the vendor or event planner,
or as referenced above for extended-day trips, overnights, and/or high-risk activities. An electronic or paper
version of this form should be retained by the troop leader for five years.
COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. As with any
social activity, participation in Girl Scouts could present the risk of contracting COVID-19. While GSGLA takes
every safety and preventative precaution, GSGLA can in no way warrant that COVID-19 infection will not occur
through participation in GSGLA programs.
Yes No
Initials
Permission for Activities My girl has permission to attend regular troop meetings,
boothing activities for the product programs, and travel to, attend, and participate in troop
and council-sponsored activities that are no longer than eight (8) hours in duration. Total
time includes drive time and event/activity time. Anything that through the normal course of
drive time and event/activity time that is 8 plus hours in duration is to be considered an
extended-day event/activity and will need approval by using the Parent Permission Form.
Yes
No
Initials
Permission to Use Photographs:
I understand that when participating in Girl Scout activities my girl may be photographed for
print, video, or electronic imaging to be used in promotional materials, news releases, and
other published formats for either Girl Scouts of Greater Los Angeles (GSGLA) or Girl
Scouts of the USA (GSUSA) or my troop/group.
I acknowledge that the images will be the sole property of either GSGLA or GSUSA or the
troop/group.
I hereby consent that the videotapes, photographs, motion pictures, electronic images
Name of Girl Scout
Troop # Service Unit #
Address
Telephone
City/State/Zip
Printed Name of Parent/Caregiver Home Phone
Relationship to Child
Email Address
Mobile Phone
Emergency Contact Name
Emergency Contact Phone(s)
Relationship to Child
Emergency Contact Name
Emergency Contact Phone(s) Relationship to Child
For all activities
the troop/group leader/advisor will notify me of the following (as applicable): events/activity
and location, place and time of departure, place and time of return, mode of transp
ortation,
equipment/clothing needed, amount of money needed by each girl, first
-aider, and troop/group emergency
contact
. Communication may be via email, Volunteer Tool Kit, closed social media groups, Shutterfly page,
text,
or other form of communication, as determined by the troop/group.
October 1, 20___ to September 30, 20___
6/2020 2
and/or audio recordings of my girl may be used by the troop/group for public relations,
publicity, and/or personal troop/group purposes. I understand that her last name and
residence will not be used.
Yes
No
Initials
_______
Permission for Emergency Medical Treatment: In the event of an emergency, every effort
will be made to contact a parent/caregiver or emergency contact. I hereby give authorization
to Girl Scouts of Greater Los Angeles to seek treatment for my child and/or dependent minor
by a licensed physician pursuant to California Family Code Section 6910 and California Civil
Code Section 25.8. I know of no reason(s) why my girl may not participate in prescribed
activities except as noted on the Health History Form. If permission for emergency medical
treatment is not given, I will prepare a signed statement providing the reason, a release of
liability, and alternate instructions and attach to this form.
Yes
No
Initials
_______
Permission to Survey: I understand that my girl may occasionally be asked to participate
in evaluations/surveys as part of her Girl Scout activities. I understand that her participation
is voluntary, and that she will neither receive compensation of any form for participating nor
will her standing in her Girl Scout sponsored programs be affected, if she chooses not to
participate. I further understand that my girl's confidentiality will be protected throughout the
entire project and that she will never be identified in any publication, written or spoken. I
understand that she may discontinue taking evaluations/surveys at any time without
consequence.
Yes
No
Initials
_______
For Sensitive Issues Only: I understand that during the course of an activity, my child may
be exposed to issues and discussions that are, or could be, considered to be of a sensitive
or controversial nature. I understand that I am responsible for communicating to the leader
and adult-in-charge about any needs that my child may have in regards to sensitive topics.
I am confident of her maturity and ability to participate. For planned discussions, the
leader(s) will inform parents of dates and topics that will be discussed.
Parent/Caregiver Responsibility: It is your responsibility to support your girl’s troop/group by:
• Providing supervision for your child before and
after Girl Scout activities – never leave her unattended
• Letting troop adult volunteer know where you can be
reached if not at the numbers listed above
• Updating the troop adult volunteer if information o
n this
form changes
• Picking your child up on time
•
Returning paperwork ahead of time
•
Notifying the troop adult volunteer if your child will be
absent
•
Helping when needed/asked
• Ensuring that the emergency contact is available
HOLD HARMLESS
I,____________________ , on behalf of myself and my minor child (or children) or ward (if applicable), and in
consideration of my child’s or ward’s involvement and participation in any and all Girl Scout Greater Los Angeles
(“Girl Scouts”) activities, hereby agree that neither I, nor anyone claiming through me, will hereafter bring,
commence, prosecute or maintain, or cause or permit to be brought, commenced, prosecuted or maintained, any
claim, right of action, or suit, either at law or in equity, in any court in the United States or in any state thereof, or
elsewhere, against the Girl Scouts, or its successors and assigns, for, on account of, arising out of, or in any way
related to any damages or injuries arising from or related to the use of any real and
personal property (“Property”)
owned, leased, or otherwise controlled directly or indirectly by the Girl Scouts, and/or the involvement or participation
in any Girl Scouts activity.
Further, I agree that I will defend, indemnify, protect
, and hold harmle
ss the Girl Scouts, and its successors and
assigns, from any and all claims, demands, damages, loss, costs, expenses, and
attorneys
fees arising from or
related to my or my child’s or ward’s use of the Girl Scouts’ Property and/or the involvement or participation in any
and all Girl Scouts activity and which arise from my, or my child’s or ward’s, acts or omissions.
Parent Agreement: I have read and understand this Annual Parent Permission Form. I may change or
revoke any aspect of this
agreement at any time by submitting my request, in writing, to the troop/group
leader.
_______
_________________________________________________________________________________________
Signature of Parent/Caregiver Date
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This form obtains parentcaregiver permission for all troop (Girl Scouts of Greater Los Angeles)

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Completed 25 July 2021

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