Adult trip leader's name : Email address:

Leader's Address:

Phone number: Cell or emergency number:

Number of Registered Girl Scouts:
Daisy: Brownie: Junior: Cadette: Senior: Ambassador:

Adults: Female: Male:

Number of non-member(s): Youth Adult:

Activities Planned:

Departure Location: Time:

Return Location: Time:
Please mail or email a copy of any agreements/contracts that will be signed for activity of use of equipment.

Form(s) of transportation for troop (Please be sure to check yes or no for all options):
Private Car: Yes, No
Rented vehicle: Yes, No
Bus: Yes, No
Train: Yes, No
Boats: Yes, No
Walking: Yes, No

List Drivers with Transportation Card (First and Last Name)

First and Last Name(s) of Certified First Aider attending trip:

Trip Cost per person: $
Total Trip Cost: $
Cost covered by each person: $
Cost covered by troop: $

Emergency Contact Person NOT ON TRIP:
First and Last name:
Home Phone: Cell Phone:
Address: