Trip Planning Summary
form #119a • 10/21 • page 1 of 2
Please describe what activities/Girl Scout programming
the troop/group will be doing on the trip:
Check Safety Activity Checkpoints (SACs) for each activity.
If the activity is high-risk, include the approved outfitter, and check SACs
If the activity requires an adult with certification (see Trip Planning Guide),
include here.
Please list what progressive experiences the troop/group has that have prepared girls for this trip:
(see GSOSW Council Volunteer Policies & Procedures)
If Daisies are attending and/or you are bringing adults beyond safety ratio, please explain:
Due to COVID-19 continuing to present significant health and safety challenges across the council, proof of vaccination is
required for overnight troop travel. Unvaccinated members must submit negative COVID-19 test results before traveling.
Trip Planning Summary (TPS) Instructions
Please consult the Troop/Group Trip Planning Guide for instructions on how to go on a girl-led trip and for a trip checklist.
Date Due:
Submit at the beginning of the planning process at least four to six (4-6) weeks prior to the departure
date. Approval is required prior to making reservations or purchases for the trip.
Submit to:
Your service unit travel coordinator. If you are unclear who this person is, please reach out to or call 503-977-6800.
Trip and Troop/Group/Patrol Information
Troop Leader: Phone #: Email:
Troop #:
Service Unit #:
Trip Destination:
Length of Trip:
1 2 3 Overnights
Day trip with high-risk activity
Departure Date:
Return Date:
Ratio Verified:
D BR JR CAD SR AMB # of Girls: ________ # of Adults: ________
This paperwork is required for any day trip with a high-risk activity and/or for an overnight trip
of one to three nights. Not required for day trips that do not include high-risk activities. Trips of
more than three nights or more than 200 miles outside of council borders require extended
travel forms #121a and #121b.
Trip Planning Summary
form #119a • 10/21 • page 2 of 2
Trip Budget Check-in: See Troop/Group Trip Planning Guide for more detailed budget worksheet
Troop/Group Funds Contributed:
Expected Cost per Girl:
Family/Girl Contribution:
Expected Cost per Adult:
By signing below, I verify that the information provided on this form is true to the best of my knowledge.
Troop Leader Signature:
Date (mm/dd/yy):
For TC use only Approved: Not Approved:
Travel Coordinator Name:
Travel Coordinator Signature:
Date (mm/dd/yy):
Travel Coordinator Notes
Type of trip:
Day trip with a high-risk activity (check to see which Approved Outfitter they are using)
Indoor Overnights – no outdoor cooking, sleeping inside or with access to indoor bathroom, kitchen
Cabin Camping/Outdoor Overnights – cooking outside/with fire, no access to indoor bathrooms, kitchen
Backpacking/primitive camping
Trip leader must initial each line below:
We agree to follow GSOSW In-Person Troop/Group Meeting Guidelines, Safety Activity Checkpoints and GSOSW policies
and procedures, federal and state laws.
Adult attendees who work with girls and/or are counted towards girl-to-adult ratio must have: current membership, a
completed background check, GSOSW Foundations online training, and GSOSW Mandatory Reporter online training.
All participants/guardians have been informed of the travel plans including, but not limited to:
departure and arrival times
all destinations and activities
emergency contact information
type of transportation
The established emergency contact (an adult not attending the trip/high adventure activity) has a copy of the itinerary,
roster, carpool list and health forms of who is attending. This person understands they are responsible for knowing the
whereabouts of the group at all times.
A signed permission form for each girl, from each girl’s parent/guardian, is in trip leader’s possession at all times. All
participants (girls and adults) have provided the trip leader with an up-to-date health history form. A copy of each girl’s
signed permission form, with health history, is given to each driver and emergency contact.
Leader will ensure that licensed, responsible adult drivers (21 years or older) are familiar with council policies and
emergency procedures.
Any men in attendance have separate sleeping quarters and bathrooms.
Leader has consulted the Troop/Group Trip Planning Guide throughout girl-planning process.
At least one adult has required trainings (i.e. Day Trips, Indoor Overnights, Outdoor Skills, First Aid/CPR, etc.)
We agree to not make any purchases or reservations toward the trip before receiving approval of this form 119a.
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 trip must
be cancelled due to unforeseen circumstances.
All funds raised for travel by members of GSOSW troops are, and shall be 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.
COVID-19 Trip Planning Summary
form #119cv • 10/21 • page 1 of 1
Email: Fax: (503) 977-6801 Mail: Girl Scouts OSW, 9620 SW Barbur Blvd., Portland, OR 97219
Troops planning high risk day or overnight trips must complete this form in addition to the Trip Planning Summary (form
#119a) and Training & Roster Verification (form #119b) and submit them to the service unit travel coordinator for approval.
Please complete the following questions to explain how your troop will be complying with the GSOSW In-Person Troop/
Group Meeting Guidelines on your trip.
As of October 4, 2021 all members wishing to travel overnight must show proof of COVID-19 vaccination. All unvaccinated
participants must follow CDC guidelines for unvaccinated travelers, including: submitting proof of negative test results 1-3
days before the trip, testing upon returning from the trip, and self-quarantining for 7 days.
Troop trips are approved on a case by case basis. If you have questions, please contact
Please review the Girl Scouts Together document for a complete list of the in-person troop/group meeting guidelines to
ensure your troop travel plans align. High risk activities require GSOSW outfitter approval which may take 4-6 weeks. To
request the approval of an outfitter, please fill out the approved outfitters request form.
Please explain in detail how your troop will comply with the GSOSW In-Person Troop/Group Meeting
Guidelines on your trip in the following areas:
Transportation ______________________________________________________________________________________
Overnight accommodations
Restroom use
Food handling and serving
Unvaccinated participants
Acknowledgment of Responsibilities
I certify that the information on this form is correct and current to the best of my knowledge. I agree to ensure all
participants comply with all COVID-19 In-Person Troop/Group Meeting Guidelines listed above. I certify that all adult and
girl members participating in this trip have signed the Assumption of Risk, Release and Waiver of Liability Relating to
I acknowledge that GSOSW reserves the right to deny and/or cancel any trip, should our plan fall out of compliance with
current GSUSA and council safety standards, policies and procedures.
Leader signature
________________________________________________________ Date _____________________