EmailMe Form - Adult Application for Travel Patrol Chaperone

If elected to be an adult patrol member, you will partner with other volunteers to:

• Oversee the safety of all GSOC girls during this trip
• Attend monthly planning meetings
• Encourage Girl-Led planning
• Enjoy mentoring Girl Scouts in a unique travel experience!
Please click the photo above to view the Travel Patrol Chaperone position description
If you are interested in applying to be an Adult Patrol Chaperone, please complete this application.
Name: *
First Last
Your volunteer position: *
Your email address: *

(please re-enter email to confirm)
Your Phone *
### - ### - ####
Service Unit: *
Troop Number or GSI
Troop Levels you have worked with: *
Daisy
Brownie
Junior
Cadette
Senior
Ambassador
Other
Girl Scout training you have completed in the last 8 years: *
New Leader Orientation
First Aid/CPR certified
Daisy level training
Brownie level training
Junior level training
Cadette level training
Senior/Amb. level training
Travel Training
Other
Please list any additional training or certification you currently hold that might be applicable:
Please rate each of the trips below to show your interest in chaperoning.
RATING SCALE:
1 = I would LOVE to chaperone this trip
2 = I would LIKE to chaperone this trip
3 = I would chaperone this trip only if needed
4 = I am not interested in chaperoning this trip

	1st choice	2nd choice	3rd choice	4th choice
Brownie Travel Patrol - Train Trip - January (annually)	1	2	3	4
San Francisco - 5th grade Juniors - April (annually)	1	2	3	4
New York & more - Cad/ Sen/Amb - July (every other year)	1	2	3	4
SAvannah, GA - Cad/Sen/Amb - February (every other year)	1	2	3	4
Phoenom! National GS Convention, Orlando, FL - Senior, Ambassador - July (every other year)	1	2	3	4
Presidential Inauguration Ceremony - Cadette, Senior, Ambassador - January (every four years)	1	2	3	4
International World Center: London & India - Senrio/Ambassador - every three years	1	2	3	4

Please provide a reference who can speak to your Girl Scout travel experience:
Reference Name: *
First Last
Email *

Confirm
Phone *
### - ### - ####
Please describe why you want to participate in Travel Patrol Chaperone Opportunities *
What ideas do you have for building relationships to create a sense of team within the patrol? *
Any additional comments?
Do you have any physical or medical conditions that we might allow for, in these meetings? *
No
Yes, briefly explain
I have read the job description for this role, and will adhere to the role requirements described. *
No
Yes
Signature *
Clear