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If any trip lasts longer than two (2) overnights and/or any non-members are attending, you will need to purchase additional
activity insurance. For more information, please refer to the Additional Activity Insurance Procedure.
HIGH-RISK ACTIVITIES – For more information,
review the Safety Activity Checkpoints for your activity. Please refer to the
High-Risk Activity Procedure for special instructions regarding the approval process for these activities and age restrictions.
Horseback riding stables
Hayride
Target sports (archery)
Gymnastics facility
Snow sports (skiing/tubing/sledding)
Target sports (firearms)
High-adventure outfitters
Transportation/bus companies
Watercraft/rentals/outfitters
Challenge/rope/climbing course
Activities with motorized vehicles (such as jet ski’s/go-carts)
*Non-commercial aircraft (such as helicopters, non-tethered hot air balloons)
Swimming/water sports
*Please refer to the High-Risk Activity Procedure for activities not permitted.
For High-Risk Activities—A current certificate of liability insurance:
Attached file with GSWPA—please check GSWPA website for a list of certificates already on file which can be found on the
On
Volunteer page under “Places To Go”. For more information, please refer to the Certificates of Insurance Procedure
CERTIFIED/TRAINED ADULTS – Must be present at all times AND submit copies of certifications/training cards
with this form. Lifeguards MUST have their certifications and photo identification on their person while they are lifeguarding.
First-aid certified adult
Exp Date
CPR certified adult
Exp Date
Travel Trained adult __________________________________________Course Date_________
Outdoor 101 trained adult
Course Date
Basic Camping Skills trained adult
Basic Tent and Yurt Camping Skills
Course Date
Course Date
Other certifications (Lifeguard, Archery, Watercraft, Low Ropes Challenge Course or Outdoor trainings attended prior to 2008)
Adult
Course Name
Exp Date
Adult
Course Name
Exp Date
TRANSPORTATION – Refer to the Transportation Procedure for ALL transportation requirements.
Car(s):
Rental vehicle
Bus/tour company name
For Bus/tour companies—A current certificate of liability insurance ($5 million minimum) is required:
Attached file with GSWPA—please check website. For more information, please refer to the
On
Transportation Procedure and the Certificates of Insurance Procedure
EMERGENCY CONTACT The emergency contact must be able to be reached during the activity/trip,
hold participant information and notify parents/guardians of delays, emergencies, cancellations, etc.
Emergency contact name:
Phone-Day
Evening
Address
Street
City
State
Zip
SIGNATURE AND APPROVAL
I verify that we will review and comply with the Safety Activity Checkpoints
Troop/Group Leader Signature
for these activities/trips:
Date
APPROVAL– For council use only:
Date received
Date approved
Signature of membership staff
If application for camping at a non-council owned site:
Outdoor Program Director approval - non-council owned site:
Date approved ___________ Signature_________________
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