EmailMeForm
High Adventure Activity Application
Become a G.I.R.L.. This form is to be filled out and submitted for approval 4 weeks prior to expected date of any High Adventure activity if company is currently GSOC approved and 8 weeks prior if company is not currently GSOC approved.
Please refer to Safety Activity Checkpoints, Volunteer Essentials, and Policies and Standards for activity planning.
Responsible Adult in Charge:
*
First
Last
Address:
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Phone:
###
-
###
-
####
Email Address:
*
(please re-enter email to confirm)
Troop Number:
Troop Level:
Daisy
Brownie
Junior
Cadette
Senior
Ambassador
Daisy Scouts can participate in High Adventure allowed by GSUSA Safety Activity Checkpoints.
Service Unit:
*
Please select
101 Brea
102 Fullerton/La Habra
103 La Cypress Park
104 Anaheim
105 Los Alamitos/Rossmoor
201 Placentia
202 Yorba Linda West
203 Yorba Linda East
204 Orange Villa
205 Anaheim Hills
206 Santiago Creek
301 Seal Beach
302 West Garden
303 Huntington Harbor
304 Ocean View
305 HB Pierside
306 Surf City
401 Garden Valley
402 Tustana
403 Tustin East
404 Newport Mesa
405 Newport Harbor
501 South Irvine
502 Heart of Irvine
503 North Irvine
504 Laguna Beach
505 Aliso Viejo
506 Niguel Coast
507 San Clemente
602 Lake Forest
603 Rancho Portola
604 Mission Viejo
605 Rancho Trabuco
606 Oso Valley
607 Ladera Valley
701 Comadres
702 Comadres North
OTHER
If "OTHER" Please explain below:
Date of GSOC background clearance:
MM
/
YY
Anticipated dates of activity:
Activity Location:
Name of Certified First Aid Provider:
Level of Certification:
Level 1
Level 2
Certifying Agency:
Expiration Date on Card:
MM
/
DD
/
YYYY
Name of Adult Lifeguard (if required):
Expiration Date on Card:
MM
/
YY
Please check all activities that apply:
Archery
Backpacking
Bicycling with Rentals
Boating
Canoeing
Caving
Challenging Courses
Fishing with Vendor
Go Carts
Horseback Riding
Ice Skating
Kayaking
Knife Throwing, Tomahawk Throwing and Zorbing
Rappelling
Rock Climbing
Roller Skating
Sailing
Scuba Diving
Segway
Skiing
Sledding
Snowboarding
Snowshoeing
Snow Tubing
Surfing
Water Skiing
White River Rafting
Ziplining
Other (please specify):
Other High Adventure Activity:
Company/Private Instructor Name:
Contact Person:
Address:
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Phone:
###
-
###
-
####
Email Address:
Check all that apply:
*
I have read and will adhere to all guidelines in Girl Scout Safety Activity Checkpoints, Volunteer Essentials and Policies and Standards
Company is currently approved by GSOC
Company is currently NOT approved by GSOC
I have current Health History and Permission Slip forms for all girls in troop/group.
All girls in troop/group are prepared for this activity both physically and mentally
I have given a Safety Briefing to all attending Responsible Adults
Safety Activity Checkpoints [https://www.girlscoutsoc.org/content/dam/girlscoutsoc/documents/Safety-Activity-Checkpoints.pdf]
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Signature:
*
Clear
By submitting this form, I confirm that the information in this form is correct to the best of my knowledge.
File Upload
If facility requires a signed form for use of their facility; upload the document here. The forms must be signed by an authorized GSOC representative (even if you already signed it). This review is required as it is GSOC procedure, don't assume personal risk when GSOC will assume the risk for you. We're looking out for you! (tip - scan all pages into one document).