Let’s GO!Out and About

Formerly known as:OCC

BOOTCamp Consultant I

Classroom Reminders

• Sign in

• Please set cell phones on vibrate

• If you need to answer your phone, please step outside

• Housekeeping

• Restrooms Breaks

Facilitator's Information• Sabrina LeMay• 512-567-3073• slemay1@austin.rr.com

Introductions• Name• Camping experience

• Novice• Beginner• Family• Experienced• Survival

• Program Level• What would you like to learn or take away

from today’s class?

Out and About• No fires• Field trip• Day trip more than 100 miles • Staying out past midnight• Tours lasting more than 24 hours• Overnight or camping up to two nights with no

outdoor cooking

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Path of Let’s Go! Training • Let’s GO! 1 - Out and About: This course will be required for troops taking a day trips more

than 8 hours to simple overnight (hotel, cabin camping with indoor cooking only - up to two

nights). This class will cover required paperwork, safety-wise ratios, budget, places to go,

things to do, etc.

• Let’s GO! 2 - Fire, Food and Fun: Pre-requisite: Out and About. This course allows you to

build fires, teaches fire safety, simple one pot meals and s’mores! (Does not include the use

of portable stoves.) This is a skills based class and each participant must demonstrate the

skills taught in the class.

• Let’s GO! 3 - Outdoor Skills: Pre-requisite: Fire, Food, and Fun. This course allows you to

take your girls on a one or two night overnight in tents, and cabins. This course prepares

girls and adults to go on a basic campout and covers the eight basic outdoor skills. This is a

skills based class and each participant must demonstrate the skills taught in the class.

• Let’s GO! 1, 2, & 3: An overnight course which covers everything in Out & About, Fire, Food &

Fun, and Outdoor Skills. This is a skills based class and each participant must demonstrate

the skills taught in the class.

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Path of Let’s GO! Training (con’t)• Chaperone: This course is highly recommended for all adults who will be traveling with a

troop. Will cover the key points from Out and About and Extended Travel to ensure all adults

understand the importance of being a chaperone, proper behavior, in the event of

emergencies, and safety-wise requirements.

• Let’s GO! Extra Mile: Pre-requisite: Out and About. This course will be required for

troops/groups traveling for more than two nights/three days, regional, national, and

international. This class will discuss required paperwork, medical forms, international forms,

Intent to Travel forms, budgets, insurance, money earning applications, and how to plan an

extended travel with the girls.

• Advanced Outdoor Courses: Pre-requisite: Outdoor Skills. These courses will be offered

throughout the year and vary as trainers offer opportunities in areas of their expertise.

Your RoleThe primary responsibility of the Let’s GO! trained person is to prepare the girls and accompanying adults for their outdoor adventures. QUALIFICATIONS OF THE LET’S GO! TRAINED ADULT:• Currently registered Girl Scout• Has a Criminal Background Check (CBC) on file with GSCTX• Completes the required outdoor training• Facilitates planning by the girls• Accompanies the girls on the outing• Assists the girls in carrying out plans• Evaluates the outing with the girls.

Planning an outingo BEFORE THE OUTING, THE LET’S GO! TRAINED PERSON:

• Sets the tone for the outing by modeling and demonstrating appropriate behavior, skills and attitude toward the outdoor world.

• Guides the girls in planning their outing.• Makes sure that health and safety requirements are met as outlined in Safety Activity Check Points and GSCTX

Council policies.• Fill out necessary forms to secure council permission for the troop, secures the site through Registration and

arranges for equipment.• Teaches the required skills so the girls as a troop can perform each skill comfortably.• Assigns tasks to patrols insuring equal participation.• Identifies responsibilities and instructs accompanying adults.

o DURING• Supervises planned activities, offering assistance and guidance as needed.• Insures health and safety standards are followed.• Reviews emergency procedures, and simple first aid with girls.• Adjust the plans as necessary to meet unexpected situations.• Allows the troop to proceed at its own pace in performing assigned tasks.• Oversees site cleanup.

o AFTER• Evaluates the outing with the girls and attending adults. It helps recognize what to do differently the next time

and how to improve the trip experience. • Recommends the next step to troop leaders and girls.• Sees that all borrowed equipment, completed paperwork, and keys are returned as appropriate.

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Everyone Should Know…

• What is the schedule for the trip or where is it posted?

• Who is the first aid person for the group?

• Where is the kaper chart?

• What is the meal plan for the trip?

• What the back-up plan is in case of severe weather?

• What are the General Emergency Procedures for your camp area?

• Where is the designated evacuation area?

• Where is the nearest telephone or where is the person who could tell you where it is?

GSLE -15 OutcomesDISCOVER• 1. Girls develop a strong sense of self.• 2. Girls develop positive values.• 3. Girls gain practical life skills.• 4. Girls seek challenges in the world.• 5. Girls develop critical thinking.

TAKE ACTION• 1. Girls can identify community needs• 2. Girls are resourceful problem solvers.• 3. Girls advocate for themselves and others, locally and globally.• 4. Girls educate and inspire others to act.• 5. Girls feel empowered to make a difference in the world.

CONNECT• 1. Girls develop healthy relationships.• 2. Girls promote cooperation and team building.• 3. Girls can resolve conflicts.• 4. Girls advance diversity in a multicultural world.• 5. Girls feel connected to their communities, locally and globally.

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Let’s GO! covers from Look Out through Camp out

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Progression of Girls

Girl Leadership

Adult Leadership

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Progression in Outdoor Activities• Troop Meeting

• Field Trip ()

• Day Trip ()

• Sleep Over

• Cook Outs

• Cook Outs • Sleep Out • Camp Out

• Travel more than 2 nights

Permission Slip required Troop/Group Travel application

Extended Travel application

Out & About HandoutVolunteer Essentials Chapter 6Troop Travel App & Roster

Handwritten Signature versus Electronic Signatures

• Forms are now Adobe fillable

• Adobe Reader version 7 or higher

• Forms state handwritten vs. electronic signature

• Examples of electronic signature

Ha n dwri tten Signature

versus

Electronic Signatures

With the implementation of the online registration process, parents are now allowed to grant permission for their daughter to participate in GS by completing the online form. This permission is considered an electronic signature.

Along with the online registration and the revision of the forms, Council staff and volunteers have determined that some forms may be signed electronically. Each of the revised forms will state in the lower left hand corner, what type of signature is required.

If a form requires a handwritten signature, you will need to complete the form prior to printing it using an Adobe reader. Then save the form, print it, and sign it.

If the form allows an electronic signature you will need to utilize a secure electronic signature that:

(a) is unique to the person making the signature; (b) the technology or process used to make the signature is under the sole control of the person making the signature; (c) the technology or process can be used to identify the person using the technology or process; (d) that is secured with a password when attaching it to the document,

Below are examples of acceptable electronic signatures:

EXAMPLE 1:

EXAMPLE 2:

EXAMPLE 3:

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Girl/Adult Health History Form:To be maintained in a secure location by adult in charge

Handwritten Signature Required Girl/Adult Health History form

Girl Scouts of Central Texas

Girl or Adult Health History Record oth pages must be completed & signed by the custodial parent/guardian of girls; or by adult members for themselves. This record will be retained by the adult leader for one year and accompany the adult in charge at all meetings and other activities (i.e. field trips, camping, SU events, etc.). This form will be shredded after a new form is received. If the individual listed on the form leaves the troop, this form will be immediately shredded. All information on this form will be kept confidential and stored in a place where others may not view the information contained on this form. For adults: complete the information that is necessary for the Girl Scout troop or event.

Full Legal Name: Nickname: Troop #:

DOB: Age: Girl Adult

Address:

Custodial Parent/Guardian if Under 18: Best Phone #:

Address (if different than girl’s address):

Emergency Contact: Best Phone #:

HEALTH CONDITIONS: PAST AND PRESENT [Check all that apply] Arthritis Hernia

Asthma Hypertension/High Blood Pressure

Bedwetting Intestinal Disorders/Constipation

Bleeding disorder Kidney/bladder illness

Convulsions/Epilepsy/Seizures Menstrual cramps

Diabetes Musculoskeletal Disorders

Diseases of the Ear or Ear Infections Mental/psychological disorder

Eating Disorders (Anorexia, Bulimia, etc.) Nosebleeds

Eyesight Impairment Sinusitis (Sinus Infections)

Fainting/dizzy spells Sleep Disturbances

Headaches/Migraines Speech Impairment

Hearing Impairment Had surgery or hospitalized in the last 5 years

Heart Defects/Disease Currently under doctor or psychologist’s care

Other:

Date of last health examination: Were any complicating medical problems noted in the last health exam? Yes No

Please explain in detail any items checked above:

Since last health exam, has participant had:

A serious injury requiring medical attention? Yes No Treatment in a hospital or emergency room? Yes No

A surgical procedure or fracture? Yes No Any exposure to a contagious disease? Yes No

Does your child have any restrictions concerning physical activities? Yes No Explain:

ALLERGIES Allergies Reaction/ Severity Treatment Date of last Reaction

Does she/you suffer from Anaphylaxis?* Yes No *A severe allergic reaction marked by swelling of the throat or tongue, hives, and trouble breathing.

Does she/you carry an Epipen? Yes No Does she/you carry an inhaler? Yes No

PHYSCIAN/DENTIST, HOSPITAL, AND INSURANCE INFORMATION

Physician’s name: Phone #:

Medical Insurance Carrier name: Insurance number:

Preferred hospital:

Dentist’s name: Phone #:

Dental Insurance Carrier name: Insurance number:

Girl Scouts of Central Texas

Girl or Adult Health History Record

Full Legal Name: Nickname: DOB:

RECORD OF IMMUNIZATION [MUST BE COMPLETED IN DETAIL]

Im m unization Date Series Com pleted

Year of Last Booster

Immunization Date Series Com pleted

Year of Last

Booster Hepatitis B Hepatitis A Diphtheria, Tetanus, Pertussis (DTap/Tdap) Inactivated Poliovirus (IPV) Measles, Mumps, Rubella MMR) Influenza Rotavirus (RV) Varicella Haemophilus influenzae (type b Hib) Meningococcal (MCV) Pneumococcal (PCV) Human Papillomavirus (HPV) Tuberculin Test: Result Date Other:

PRESCRIPTION MEDICATION List any medications including dosage schedule and specific instructions for use. ALL prescriptions must be in the original container with appropriate label.

Medication Purpose Dosage Specific instructions

OVER-THE-COUNTER MEDICATIONS: Parent/Guardian of Minors: my daughter has permission to take the following medications in case of accident or injury:

Tylenol/Acetaminophen Pepto Bismol

Aspirin (fever reducer) Imodium (anti-diarrhea)

Ibuprofen (pain/swelling) Dramamine (motion sickness prevention)

Benadryl/Antihistamine Tums/antacid

Robitussin/expectorant Sudafed/decongestant

Skin Ointments (in case of rash, antibacterial, athlete’s foot, etc.)

Other:

Special considerations or notes:

I have reviewed the GSCTX policy on administering medication to a minor and submitted the appropriate permission forms to the adult in charge. Yes No N/A - My child is not currently taking any prescribed or over the counter medications.

My child has the following dietary restrictions:

SIGNATURE(S)

For Custodial Parents/Guardians: I know of no reason(s), other than the information indicated on this form, why my daughter should not participate in prescribed activities except as noted.

Signature of Custodial Parent or Guardian Today’s Date

For Adults: This health history is correct and I am able to participate in all prescribed activities except as noted.

Signature of Adult Today’s Date

Attach picture of individual here.

Appendix

Permission Slips – maintained by adult in charge

Girl Scouts of Central Texas

Permission for Meetings, Media, Day Trips & Treatment

Page must be completed & signed by custodial parent/guardian of girl. Health history form must be completed and attached to form.

Girl’s Full Legal Name: Nickname: DOB:

SAFETY AGREEMENT FOR MEETING

1. Will your daughter be walking home from meetings? Yes No 2. Will someone be driving her home from meetings? Yes No 3. My daughter is allowed to use the following modes of transportation: Public transportation Drive herself home 4. What is the name and phone number of the person(s) who will drive her home?

5. Will anyone else have your permission to walk, drive, or accompany her home? Name & phone number:

6. Is there anyone who is NOT permitted to pick up your child?

Name: I understand that if my daughter is to have a ride or walk home, I am responsible for seeing that the person I named in questions 3 or 4 above is there by p.m. to pick her up. (I understand that neither the leader nor Girl Scouts is responsible for driving her home or walking with her.)

Signature of Custodial Parent or Guardian Today’s Date

RELEASE OF LIABILITY AGREEMENT

I shall indemnify, hold free and harmless, assume liability for, and defend the Girl Scouts of Central Texas, its chartered affiliates, agents, servants, employees, officers and directors from any and all costs and expenses including but not limited to doctor’s fees, emergency room fees, reasonable attorney’s fees, investigative, and discovery costs, court costs, and all other sums which the Girl Scouts of Central Texas, its chartered affiliates, agents, servants, employees, officers and directors may become obligated to pay on account of any, all and every demand for, claim arising or assertion of liability, or any claim or action founded thereon, arising or alleged to have arisen out of the negligence, gross negligence or intentional misconduct relating to the event hosted by the Girl Scouts of Central Texas, its chartered affiliates, agents, servants, employees, officers, and directors.

Signature of Custodial Parent or Guardian Today’s Date

MEDIA PERMISSION

When registering for this program year (either online or on paper), I granted permission OR denied permission for my daughter to be interviewed, photographed, videotaped, or electronically imaged for purposes of promotional materials, news releases, or other published formats for either the local Girl Scout Council or Girl Scouts of the USA.

Signature of Custodial Parent or Guardian Today’s Date

PERMISSION FOR ALL ONE DAY TRIPS FOR THE YEAR

Throughout the year, there will be meetings and field trips held outside the normal meeting space. Your signature will give permission for all of our group’s local activities, including any field trips of one day or less. You will be informed in writing (handout or email) at least two weeks in advance of each field trip so you can let the leader know if you do NOT want your daughter to participate. If the leader does not hear from you, she/he will assume based on your signature below that your daughter has your permission to participate. You will need to complete individual permission slips for any activities over one day in length. You are also granting permission for your daughter/me to ride in private vehicle, tour bus, and other modes of transportation as deemed necessary by the Adult in Charge.

I agree to the Day Trip permission statement above.

Signature of Custodial Parent or Guardian Today’s Date

CONSENT FOR EMERGENCY MEDICAL/DENTAL TREATMENT I am the parent or guardian having legal custody of the child named above. I authorize all medical, surgical, diagnostic, and hospital care or procedures which may be performed or prescribed for my child by a licensed physician/dentist or hospital, when efforts to contact me are unsuccessful and when deemed immediately necessary or advisable by the physician to safeguard my child’s health. I waive my right of informed consent to such treatment. See attached health history form.

Signature of Custodial Parent or Guardian Today’s Date

EMERGENCY CONTACT INFORMATION

Custodial Parent/Guardian if Under 18: Best Phone #:

Address (if different than girl’s address):

Emergency Contact Name: Best Phone #:

Alternate person to contact in emergency:

Name Best Phone #: City Relationship

Electronic or Handwritten Signature Allowed Overnights/Extended Travel Permission form

Girl Scouts of Central Texas

Permission for Overnights or Extended Trips

This form is used for overnights and extended travel within the state, regional, or national travel. Page must be completed & signed by custodial parent/guardian of girl, or by adult traveling with troop/group at least two weeks prior to the travel. Current health history form must be on file with adult in charge of trip.

Full Legal Name: Nickname: DOB:

EVENT/TRAVEL DETAILS

Event/Travel Type: Date(s): Cost/individual: $

Location(s): Traveling by:

PERMISSION FOR OVERNIGHTS OR EXTENDED TRAVEL

By initialing the lines below, I am verifying that I have read and understand the following for either my daughter or me: She/I is/am in good physical condition at present and has/have had no serious illness or operations since the last health examination.

She/I will not attend if she/I is not feeling well. I give consent for emergency medical or dental care to be rendered by a licensed healthcare provider/dentist, if unable to reach family

physician or dentist. When registering for this program year (either online or on paper), I granted permission OR denied permission for her/me to be

interviewed, photographed, videotaped, or electronically imaged for purposes of promotional materials, news releases, or other published formats for either the local Girl Scout Council or Girl Scouts of the USA.

I give permission for my daughter/me to ride in private vehicle, airplane, tour bus, and other modes of transportation as deemed necessary by the Adult in Charge.

I understand that volunteers and GSCTX are not responsible for loss of valuables. I give consent for the First Aider to dispense medications that have been provided in its original container in the dosage as it is listed. I

have also listed any over the counter medications and the dosage that the First Aider is approved to dispense on the Health History form. I understand that she/I must abide by the Code of Conduct and any dress code that has been established by the group. If she doesn’t/I

don’t, she/I may be asked to leave and I will be required to provide transportation home. I shall indemnify, hold free and harmless, assume liability for, and defend the Girl Scouts of Central Texas, its chartered affiliates, agents,

servants, employees, officers and directors from any and all costs and expenses including but not limited to doctor’s fees, emergency room fees, reasonable attorney’s fees, investigative, and discovery costs, court costs, and all other sums which the Girl Scouts of Central Texas, its chartered affiliates, agents, servants, employees, officers and directors may become obligated to pay on account of any, all and every demand for, claim arising or assertion of liability, or any claim or action founded thereon, arising or alleged to have arisen out of the negligence, gross negligence or intentional misconduct relating to the event hosted by the Girl Scouts of Central Texas, its chartered affiliates, agents, servants, employees, officers, and directors.

I agree to the permission statement above.

Signature of Custodial Parent or Guardian, or Adult attending Today’s Date

CONSENT FOR EMERGENCY MEDICAL/DENTAL TREATMENT

I am the parent or guardian having legal custody of the child named above.

I am the individual named above.

I authorize all medical, surgical, diagnostic, and hospital care or procedures, which may be performed or prescribed for my child or myself by a licensed physician/dentist or hospital, when efforts to contact the emergency contact person are unsuccessful and when, deemed immediately necessary or advisable by the physician to safeguard my child’s health. I waive my right of informed consent to such treatment. See attached health history form.

Signature of Custodial Parent or Guardian, or Adult attending Today’s Date

EMERGENCY CONTACT INFORMATION

Custodial Parent/Guardian if Under 18: Best Phone #:

Address (if different than girl’s address):

Emergency Contact Name: Best Phone #:

Alternate person(s) to contact in emergency:

Name Best Phone #: City Relationship

Appendix

Troo

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Tr

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Date:

Service Unit:

Troop/Group:

Program Level: D B J C S A

Girl Scouts of Central Texas

Troop/Group Travel, Overnight, and Extended Application Submit the application, a complete Participant Travel Roster, and required certifications to your Service Unit Director three weeks before travel. SUD must turn in travel application packet to Membership Development Executive (MDE) two weeks before travel. Note: applications for national and international are due to SUD ten weeks in advance, SUD will forward to MDE no later than eight weeks in advance of travel.

This form does not take the place of the Intent to Travel for national and international trips. ACTIVITY (Choose all that apply)

Travel will meet Girl Scout educational expectations as defined by GSLE 15 outcomes (see Volunteer Essentials, Ch. 2 for a complete list) Day Trip: Travel destination is more than 100 miles one way from troop meeting place. Overnight stays: Girls staying past midnight, on a tour for more than 24 hours, overnight, and/or camping.

Building a fire Local State Regional National International High Risk Activities: requires certification Water sport Horses Rock Climbing Other

CERTIFICATIONS (Attach copies of cards) First Aid/CPR

Advanced First Aid Responder (if applicable to trip) Let’s GO! 1: Out & About: Day trips staying out past midnight; or an overnight up to two nights with no outdoor cooking involved. Let’s GO! 2: Fire, Food, & Fun: Indoor camping and building a campfire. Let’s GO! 3: Outdoor Skills: Outdoor camping – tent, cabin, or platform, and outdoor cooking. One to two nights. Let’s GO! 1, 2, & 3: (This course covers everything in Out & About, Fire, Food & Fun, and Outdoor Skills) Let’s GO! Extra Mile: Travel more than 2 nights/3days – within state, regional, national, or international. Chaperone: All adults traveling with troop/group have completed this course.

TRAVEL REQUIREMENTS I have read and agree to abide by all Safety Activity Checkpoint requirements, and Council policies as listed in Volunteer Essentials. I have received parent permission forms all girls on this trip, as applicable. I have verified that all adult participants have a current Criminal Background Check on file with GSCTX. I have verified that all drivers are licensed, and vehicles are registered and insured according to state requirements. For trips more than 3 or more nights/out of state, national, international – Extended Trip Insurance has been purchased (date) For non-members attending, troop/group has purchased non-member insurance (date)

EVENT/ACTIVITY AND DESTINATION INFORMATION If more than one destination of more than two nights, create and attach a travel itinerary that includes travel information, arrival/departure dates, names of all facilities, addresses, and phone numbers.

Start Date & Time: __________________________ End Date & Time: ____________________________ Total # nights:

Primary Activity:

Secondary Activities:

Name of Facility/Place: Phone:

Facility Address:

Travel by: Parent Drop off/Pick up at Location:

Departure location:

Private Vehicles – how many? Rental vehicle

PARTICIPANT NUMBERS AND ROSTER Number of registered Girl Scouts attending: Girls Adult Females Adult Males

Number of non-members attending: Girls Adult Females Adult Males

Attached is the participation/travel roster listing all girls and adults attending the trip; include emergency contact information.

TROOP/GROUP ADULT CONTACT INFORMATION Adults in charge:

Leader/Adult: Best Phone #:

Email:

Other Adult: Cell phone on trip:

Troop/Group Emergency Contact: (This individual is not attending and will have a copy of the troop itinerary.)

Name: Best Phone #:

Email:

SIGNATURES

Adult in Charge Name (Print) Signature Date

SUD Name (Print) Signature Date

Council Representative Name (Print) Signature Date

Appendix

Travel RosterSU: TROOP # Event date(s):

GIRLSFOR TRP

LEADER TO COMPLETE

Full Legal Name(Last, First)

Emergency Contact Name Best Emergency number to be reached

Registered yes/no

ADULTS Full Legal Name

(last, First)Emergency Contact Name

Best Emergency number to be reached

Driveryes/no

Registered yes/no

Chaperone Class yes/no

CBC Expiration date

First Aid Expiration date

CPR Expiration date

Advanced First Aid

Expiration date, if required

HighestOutdoor Skills Certification

TROOP TRAVEL PARTICIPATION ROSTER

TROOP LEADERS TO COMPLETE SUD'S WILL VERIFY INFORMATION

Notes, allergies, special needs, etc.

Appendix

Intent to Travel

Girl Scouts of Central Texas

Intent to Travel Application

The Intent to Travel Application must be completed, signed, and submitted to GSCTX following the guidelines listed below. Within 10 business days, of receipt of your request, you will be notified of the status of your request. This form must be approved before girls proceed with further planning.

National Travel: o Cadette, Senior, Ambassador – submit 6 months in advance o Brownie, Junior – submit 1 year in advance

International Travel: o Cadette, Senior, Ambassador – submit 1 year in advance

TROOP/GROUP INFORMATION

Submission Date: Group/Troop #: Service Unit:

Group/Troop Leader’s Name: Best Phone #:

Email Address:

Programs Age level(s): Brownie (3rd grade) Junior Cadette Senior Ambassador

Number of Registered: Girls Adult Females Adult Males

Number of Participants: Girls Adult Females Adult Males

TRAVEL EXPERIENCE

Has your group/troop planned and participated in an extended travel experience previously: No Yes

If yes, provide a description of destination, type of trip, and type of activities:

TRAVEL PLANS

This is an estimate of travel plans. A final Travel Application, Travel Roster, and required certifications must be submitted 10 weeks prior to travel. All of the chaperones will be required to complete the required training sessions and the documentation must be submitted with the travel application packet.

Departure Date: Departing From:

Return Date: Returning To:

Place(s)/Country(ies) Traveling to:

What is the purpose of this trip (i.e. service, eco-tourism, etc.)?

List all types of transportation planned (i.e. private vehicle, plane, bus, ship, train):

Are there any high risk activities on this trip? No Yes If yes, list type of activities:

BUDGET INFORMATION

Estimated cost per girl: $ Estimated cost per adult: $ Total Budget: $

Did/Does you group plan on participating in council-sponsored product sales? No Yes

Did/Does your group plan on conducting any money-earning activities? No Yes

SIGNATURES

Leader/Advisor Signature: Date:

SUD Signature: Date:

FOR COUNCIL USE ONLY:

Date Received: Approved Not Approved

If not approved, what is the reason?

Date of Notification: Council Signature:

Next Steps/Recommendations/Comments:

Appendix

Girl International Permission Girl Scouts of Central Texas

Permission for International Travel for Minors

This form is used for international travel. Minors under the age of 18 traveling from the United States to any foreign country without either of her parent(s), custodial parent, or guardian must have a notarized affidavit from the parent(s) or guardian(s) not accompanying the minor stating that:

1. The minor is traveling out of the United States with the permission of the (custodial) parent(s), or guardians. 2. That the non-traveling (custodial) parent(s), or guardians is aware that the minor is leaving on the departure date, 3. Provides the name(s) of the person(s) accompanying the minor, and 4. Provides consent to seek emergency medical/dental treatment.

This form must be notarized by the individuals who have legal custody of the minor. If the parents are not together, parent consent from both parents is still required. If one parent is the custodial parent or deceased, there must be legal proof/documentation of this status.

GIRLS UNDER 18 WILL NOT BE ABLE TO BOARD THE INTERNATIONAL FLIGHT WITHOUT THIS PERMISSION.

DO NOT SIGN FORMS UNTIL IN FRONT OF NOTARY!

Full Legal Name: Nickname: DOB:

TRAVEL INFORMATION

Travel dates: to

Travel to:

ADULT(S) TRAVELING WITH MINOR

Names of the responsible adults that will be accompanying the minor:

1. 2.

3. 4.

PERMISSION FOR INTERNATIONAL TRAVEL

By initialing the lines below, I am verifying that I have read and understand the following:

She is in good physical condition at present and has had no serious illness or operations since the last health examination. She will not attend if she is not feeling well.

When registering for this program year (either online or on paper), I granted permission OR denied permission for her to be interviewed, photographed, videotaped, or electronically imaged for purposes of promotiona l materials, news releases, or other published formats for either the local Girl Scout Council or Girl Scouts of the USA.

I give permission for my daughter to ride in private vehicle, airplane, tour bus, and other modes of transportation as deemed necessary by the Adult in Charge.

I understand that volunteers and GSCTX are not responsible for loss of valuables.

I give consent for the First Aider to dispense medications that have been provided in its original container in the dosage as it is listed. I have also listed any over the counter medications and the dosage that the First Aider is approved to dispense on the Health History form.

I understand that she must abide by the Code of Conduct and any dress code that has been established by the group. If she doesn’t, she may be asked to leave and I will be required to provide transportation home.

My daughter has the permission of her undersigned (custodial) parent or guardian to participate in an international trip with Girl Scouts for the dates and to the country(ies) listed above.

Should any accident or illness occur to her during the travel, I/we will not hold the leader, her agents, or the Girl Scouts of Central Texas responsible.

I agree to the permission statement above.

Signature of Maternal Custodial Parent or Guardian Signature of Paternal Custodial Parent or Guardian

Printed Name of Maternal Custodial Parent or Guardian Printed Name of Paternal Custodial Parent or Guardian

Girl Scouts of Central Texas

Permission for International Travel for Minors

DO NOT SIGN FORMS UNTIL IN FRONT OF NOTARY!

CONSENT FOR EMERGENCY MEDICAL/DENTAL TREATMENT

I/we authorize all medical, dental, surgical, diagnostic, and hospital care or procedures which may be performed or prescribed for my minor by a licensed physician/dentist or hospital, when efforts to contact the emergency contact person are unsuccessful and when deemed immediately necessary or advisable by the physician to safeguard my minor’s health. I/we waive my/our right of informed consent to such treatment. See attached health history form.

Signature of Maternal Custodial Parent or Guardian Signature of Paternal Custodial Parent or Guardian

Printed Name of Maternal Custodial Parent or Guardian Printed Name of Paternal Custodial Parent or Guardian

EMERGENCY CONTACT NOTIFICATION

PERSON TO NOTIFY IN THE EVENT OF AN EMERGENCY.

Legal Name: Relationship:

Contact’s 1st phone number: 2nd phone number:

Email address:

Address:

ALTERNATE EMERGENCY CONTACT:

Legal Name: Relationship:

Contact’s 1st phone number: 2nd phone number:

Email address:

Address:

NOTARY STATEMENT

In the state of __________________ and county of _______________________________________ on this day __________ of _____________________, _________, before me personally appeared ________________________________________ and ________________________________________ to me known to be the individual, or individuals, described in and who executed the within and foregoing instrument, and acknowledged that she/he/they signed the same as her/his/their free and voluntary act and deed, for the uses and purposes therein mentioned.

Given under my hand and official seal this _________ day of ____________________, _____________.

NOTARY SIGNATURE:

NOTARY PRINTED NAME:

NOTARY PUBLIC in and for the State of ________________________________.

My appointment expires on ________________________

SEAL

Appendix

Adu

lt In

tern

ati

onal

Perm

issi

on

Girl Scouts of Central Texas

International Travel for Adults This form is used for international travel. Adults traveling outside of the United States must complete this form, have it notarized, and submit the form to the adult in charge of the trip. This form provides consent to seek emergency medical/dental treatment.

DO NOT SIGN FORMS UNTIL YOU ARE IN FRONT OF THE NOTARY!

Full Legal Name: Nickname: DOB:

TRAVEL INFORMATION

Travel dates: to

Travel to:

STATEMENT OF UNDERSTANDING

By initialing the lines below, I am verifying that I have read and understand the following: I am in good physical condition at present and have had no serious illness or operations since the last health examination. I will not

attend if I am not feeling well. When registering for this program year (either online or on paper), I granted permission OR denied permission for her to be

interviewed, photographed, videotaped, or electronically imaged for purposes of promotional materials, news releases, or other published formats for either the local Girl Scout Council or Girl Scouts of the USA.

I give permission to ride in private vehicle, airplane, tour bus, and other modes of transportation as deemed necessary by the Adult in Charge.

I understand that volunteers and GSCTX are not responsible for loss of valuables. I give consent for the First Aider to dispense medications that have been provided in its original container in the dosage as it is listed. I

have also listed any over the counter medications and the dosage that the First Aider is approved to dispense on the Health History form. I understand that I must abide by the Code of Conduct and any dress code that has been established by the group. If I don’t, I may be

asked to leave and will be responsible for my transportation home. Should any accident or illness occur to me during the travel, I will not hold the leader, her agents, or the Girl Scouts of Central Texas

responsible.

I agree to the permission statement above.

Printed name of Adult Signature of Adult

RESPONSIBLE ADULT(S)

Names of the responsible adult(s) who are traveling on trip and have permission to seek emergency medical/dental treatment.

1. 2.

CONSENT FOR EMERGENCY MEDICAL/DENTAL TREATMENT

I/we authorize all medical, dental, surgical, diagnostic, and hospital care or procedures which may be performed or prescribed for myself by a licensed physician/dentist or hospital, when efforts to contact the emergency contact person are unsuccessful and when deemed immediately necessary or advisable by the physician to safeguard my health. I waive my right of informed consent to such treatment. See attached health history form.

Printed name of Adult Signature of Adult

EMERGENCY CONTACT NOTIFICATION

PERSON TO NOTIFY IN THE EVENT OF AN EMERGENCY.

Legal Name: Relationship:

Contact’s 1st phone number: 2nd phone number:

Email address:

Address:

NOTARY STATEMENT

In the state of ________________________ and county of _______________________________________ on this day __________ of _____________________, _________, before me personally appeared ________________________________________ and ________________________________________ to me known to be the individual, or individuals, described in and who executed the within and foregoing instrument, and acknowledged that she/he/they signed the same as her/his/their free and voluntary act and deed, for the uses and purposes therein mentioned.

Given under my hand and official seal this _________ day of ____________________, _____________.

NOTARY SIGNATURE:

NOTARY PRINTED NAME:

NOTARY PUBLIC in and for the State of ______________. My appointment expires on __________________

SEAL

Appendix

Safety-Wise & Safety Activity Checkpoints• Safety with the girls

• Girl – Adult ratio / program level• Adults must be registered Girl Scouts and have a

current criminal background check• Chaperone class

• First Aid / CPR• Let’s GO! Training

• Safety Activity Checkpoints

Pg 9

Is your Troop ready to go?

Refer to Outdoor Education book• How can you tell your troop is ready to leave the troop

meeting?

• When do you know when the girls are ready to spend the night away?

• Readiness Assessment

Pg 9

Readiness AssessmentPlease mark the answer that best represents how well prepared the troop/group is for the different situations. Once this course is completed, volunteers will be ready to help girls prepare for a wide variety of adventures!

Yes No Question

For younger girls, are they ready to be away from their parents for a full day?

Are the parents ready for them to be out for a full day?

Are the parents ready for their daughter to spend the night away from home?

Are the girls ready to stay overnight away from home?

Are the girls ready to manage self-care? Can they dress themselves, brush their hair and teeth?

Has each of the girls spent the night at a friend’s house?

Is each girl ready to walk the distance your girls have planned?

If the girls are planning a half-day hike, have they done a few hikes that last 2 hours or less?

If the girls are planning a full day hike, have they done some half day hikes to prepare?

If the girls are planning a trip to a Dude Ranch, have they stayed in a hotel or resort or away from home and family for two nights?

For the girls who have cell phones, are they able to be without them for an overnight?

Have the girls done any indoor cooking as a group?

Can the girls sweep up after themselves?

Can the girls wash dishes effectively?

TOTAL NUMBER OF EACH

Pg 10

Steps to SuccessGirls:

• Have girls be involved in planning.• Plan simple, no cook meals.• Come up with “rules” and “consequences” so everyone knows the

expectations.

Leaders:o Visit site before visiting.o Double check Girl Health History forms to see what problems could

arise and be prepared for it. If needed, ask the parent to tag-a-long.

Extra adults:• Chaperone class• Girl led event• Clarify roles and establish boundaries• Attend planning meetings• Assign extra parents to work with girls other than their own daughters

Together:• Evaluate the trip.

Pg 12

Revised: 07/2014

Rules of Personal Conduct• Who makes the rules?• What should be

included in the rules?• Who determines the

repercussions?

• Chaperoning Class

Pg 12

Sleeping Arrangements• Review Safety Activity Check Points

• If a female adult is sharing accommodations with girls, two adults must be present when using the sleeping quarters.

• Males must have separate sleeping and changing quarters, when staying overnight during a girl program.

• EXCEPTION: The Chief Executive Officer or her designee may make an exception to the above-listed accommodation requirements when Family Camping is involved and a family is sharing accommodations.

Pg 13

Secrets to Bedtime SuccessDarkness• Acquaint girls with building• Where is bathroom, sleep area?• Allow exploration of building and surrounding area• Talk about “night” noises the girls might hear. • Is the building close to the highway? Are there a lot of sirens? • Will they hear crickets and birds? • Depending on the time of year, they may hear birds before 5:00 AM. • Permit nightlights or flashlights for girls who are afraid of dark• Exploring the area around the building in the evening can be a lot of fun. Bedding• Do not use a slumber bag alone. Bring a fleece blanket in case you get cold.

Nighttime Behavior• At bedtime be very clear how you expect the girls to behave should they awaken early. Perhaps they can each have a

book by their bed.• Don’t get girls over-excited before bedtime.• Don’t tell ghost stories to younger girls. Some are very suggestive and imaginative.• “Stage” the first bedtime from busy to quiet, from fast to slow. Once all the girls are in bed, progress from “talk

time”- to whisper - to read without talking - to no light and no sound.• Regardless of earlier preparation, after the girls have settled in nicely expect one last parade to the bathroom. To encourage independence in girls and to avoid any appearance of impropriety, it is strongly recommended that girls

and adults stay in separate cabins/tents/rooms whenever possible.

Pg 13

When & Where to Go?• Time of year• Day or overnight• Distance• Council Events• websites

Pg 14

Leave No Trace or Minimal Impact Camping Experience• www.lnt.org

• Leave No Trace or MICE Philosophy

• Plan Ahead• Group Size and

Behavior• Campsites

• Respect Wildlife• Fires• Food and Wastes• Soap• Human Wastes• No Trace Check-up

OEGS pg 60

Pg 14

Schedule and Activities• Meals?• Activities?• Free Time?• Bad Weather?• Bedtime?

• Fun Filled• Event• Badges, Journeys• Hike, Games, Star Gaze

Pg 14

Budget • Who pays?• Troop• Parents• 50 / 50

• Cost of Trip• Event/Site Fee• Transportation • Food• Supplies

Don’t forget to fill out an expense report

Pg 21

Revised: 07/2014

Transportation

• Vehicle?• Gas cost

• How many?• Adult family members• Directions• Time

VE chapter 4

Pg 21

Safety• Buddy System• Lost• First Aid kit• Emergency Contacts – phone list• Emergency Procedures• Medicine Woman

Pg 22

What to do if you become separated from the group • Buddy System• Adult Chaperone• Carry whistle. Three blasts is universal signal of distress• Don’t move, sit tight, hug a tree

Lost

Pg 22

Revised: 07/2014

Troop First Aider:• All minor injuries/ illnesses logged into a medical

sheet • Emergency room or sent home• First Aid kit

Incident/Accident form:• Emergency or injury• Notify GSCTX with report of injury or accident as

soon as possible.Forms:

• Health history form for each participant.• Permission forms for all participants• Forms should be in cars transporting participants

– to and from.• While at event, forms should be with First Aider

Emergency Situations

Pg 24

Intense Weather SituationsThunderstorms

• Attempt to get into a car or building. If that is not possible, get to an open space and squat on ground as low as possible.

• Do not lie flat on ground.• If you are in a wooded area, find location protected by clump of trees. Avoid tall

structures (towers, tall trees, fences, telephone or power lines.• Stay away from rivers, lakes or other bodies of water.• Stay away from metal objects (fishing rods, bikes, etc).

Hail• Take cover immediately.

Heavy Winds• Be careful of falling branches and blowing

debris.• If possible, get inside of a building.• Get away from windows.

Flooding• Verify evacuation routes• Move group to highest location• Do NOT drive through low water crossings

• Notify authorities of your location

Pg 24

Hotel Safety• When making reservations, ask for the rooms to

be together• Have key to all rooms• Review what happens if someone gets lost• Be respectful of staff and other hotel guests• Tell girls expected behavior• Enforce buddy system• Review what to do in an emergency. In multi-floored

facilities, they rarely evacuate all floors at the same time. It may be that the floors directly above and below a fire are evacuated first to avoid overcrowding in the stairways

• Establish meeting place outside the hotel, away from main entrances. This will be important in the event of an emergency

• Make sure girls know which room you are in, as well as fellow members

Pg 25

Hotel Fire Safety• Fire drills in hotels are often organized by floors. The floor

above and the floor below, along with the floor where the alarm sounded, will be evacuated first. This avoids putting too many people in the stairways at the same time.

• When you check in to the hotel, ask for the evacuation procedures. They are usually on the back of each hotel door. Review these with the girls.

• Find the fire exits on the floor where the rooms are. Make sure everyone knows where all the exits are as the fire may be on one side of the hotel and they will need to use the other exit.

• Establish a meeting spot near the hotel. Avoiding the front entrance as this will be clogged with emergency vehicles and personnel.

Pg 26

Fire Drill at Sites• Leaders should discuss and practice fire drill procedures with girls• Troop/groups/groups should conduct a fire drill once they arrive at

site.• The fire alarm given by a car horn or whistle is 3 beeps or blasts ‑

pause ‑ 3 beeps or blasts.• Girls move to designated spot to meet their leaders for a head count.• After headcount, campers proceed single file along the path or camp

road to the nearest exit, or as directed.• One leader/adult is in front, and one is in the rear. • Heads should be covered.• The group should move silently and quickly, but NOT run.• If anyone is missing, the leaders and girls must determine quickly who

is missing and where she/he was last seen. One or more adults will take the troop/group to the nearest exit, or as directed. One leader and at least one other adult will stay and look for the missing person, perhaps with emergency personnel.

In the event of a real fire contact the nearest fire department immediately.If time allows, first extinguish all fires in fire circles.

Pg 26

Equipment• Group Equipment

• What supplies are needed for this event?

• Packing & Unpacking

• Trash

• Personal Gear• Packing list

OEGS pg 166-169Out & About handout

Pg 27

Day Trip GearGirls should create list of what is needed• Personal and troop• Appropriate clothing for trip

Day Pack:• Water bottle• Whistle• Small flashlight• High energy snack/water• Sunscreen, lip protection, insect repellants• Sit upon• Bandana• Mess Kit, as needed• Mini first aid kit, medications• Sunglass

Pg 27

Troop/Group EquipmentEquipment will depend upon trip:• Fully charged cell phone• Accident insurance form• Kaper chart, schedule, watch• Whistle for emergencies• Trash bag, dribble bucket if needed• Program supplies and equipment• Matches and cooking equipment as needed• Dishwashing equipment. Include rope and clothespins for

hanging dunk bags• Camera (optional)

Pg 27-28

Dressing for the WeatherSunny Summer Day: hat, sunscreen, sunglasses, water bottle, light layered clothing, insect repellent*

Brisk Fall Day: windbreaker/sweatshirt, hat, layered clothing, appropriate shoes

Snowy Winter Day: hat, gloves, winter coat, long underwear, wool socks and appropriate shoes.

Rainy, Chilly Spring day: raincoat, boots, layered clothing including t-shirt and sweatshirt

See Chapter 3 “Learning Outdoor Skills” in the GSUSA Outdoor Education in Girl Scouting book for more information on

“Dressing for the Weather”

*Please note that we strongly discourage the use of bug spray.

We encourage the use of lotions and towelettes.

Pg 29-30

Shoes

Not in the pool or shower but everywhere else is great!Hiking boots should only be worn while out on trails - need

to change to softer sole shoes when in camp due to erosion.

Shoes

At home, in the shower, around the pool, in buildings But never outside at GS events.

Pers

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Pa

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Troop # ________ Packing List Girls and Adults - I tems to bring to the campout:

Sack Lunch f or ___(meal)_________ . Pillow Sleeping bag/ bed roll (Adults may want to bring a air mattress) Pajamas Towel / washrag Bathroom items Hair doo-dads Clothes f or the weather – rain, cold, and warm

o Shorts, jeans o Short sleeve shirts - NO SLEEVELESS SHI RTS (THI S I NCLUDES ADULTS)

Note: White shirts attract bugs – particularly ticks and gnats! o Raincoat o J acket

Closed toe shoes f or walking around camp. (NO sandals or fl ip-fl ops! There will be a shoe check.) o Shower shoes or fl ip-flops may be worn in the shower only!

Plate, cup and silverware or messkit Dunk bag Water bottles Medications in a marked bottle with instructions and given to your Troop’s Medicine Woman. I nsect repellant Sunscreen Chair (Adults may want to bring, some areas do not have a place to sit) Flashlight Hat Bandanas Sunglasses Book or something to do during downtime

Sit-UponMaterials needed:• A large piece of waterproof material (an • old heavy-duty plastic tablecloth, • shower curtain, etc.)• Newspapers or other stuffing• Paper punch• Yarn or string and masking tape

Directions:• Cut a piece of waterproof material 2 ½ times the length of the stuffing and 6” wider.• Punch holes around the outside edge• Cut a long piece of yarn or string. Using masking tape on the end, create a “needle and thread” effect. • Girls can “sew” their sit-upon together using the holes and an overhand stitch.• Have girls create a belt or strap using more fabric, string, or rope Pg 46-Appendix

Mess Kits and Dunk Bags• Plastic dishes from a dollar store work great ! • A dunk bag is used to sterilize each person’s

dishes. • Set up wash station – final bucket is dishes are

placed in dunk bag and sanitized

A lingerie bag will also work as a dunk bag.You can make one by sewing two mesh dishrags together and adding a string.

Pg 31

Washing DishesEquipment needed to wash dishes: 3 dish pans Dish detergent Sanitizer (Check your site reservation

confirmation to see what is acceptable at the site you have reserved)

Steps for washing dishes: Scrape and presoak before washing Clean in the first bucket with hot soapy water In the second bucket, rinse the dishes with clear water. In third, use dunk bags to hold the dishes and sanitize using the

sanitizer and warm water Hang dishes in dunk bags to air dry.

Pg 32

Take Out what you Bring inGarbage• Flatten all boxes and cans to save space. If

possible, remove ends first.• Take all garbage and recyclable items home with

you.• Take all leftovers home with you. Don’t be

tempted to leave anything behind to feed the animals.

Latrines/Port-a-Jons• Never pour or throw anything into the latrine/port-

a-jon that might interfere with the natural breakdown process. Use a sink, if available, or disperse liquids by spreading them out over a large area at least 200 feet from water, camp, or trail. Cleaning a bathroom outdoors is similar to cleaning your bathroom at home.

Pg 33

Revised: 07/2014

Meals – Food• Coolers

• Menus

• Quantities

• Purchasing

• Storage

• Packing

Pg 35

Basic Cooler tips

• Use separate ice chests – drinks, perishable food, freezer

• Empty out water daily for sanitation reasons

• Freeze water in plastic bottles as ice for cooler – lasts longer, food doesn’t get water logged, no contamination, provides drinking water if needed

PROGRESSION IN OUTDOOR COOKING

Cooking and Meal Planning The first overnight with girls is not the place to try new foods – unless the girls are up for it. The girls should generate the menus, with guidance from the leaders. This is a great opportunity to work on the food pyramid with the girls. When they begin planning, they can be sure to plan balanced meals. There are several things to consider before beginning this portion of the planning process. Make sure to consider:• All cultural and ethnic constraints. • Celebrate the diversity in the troop.• Food allergies the girls and adults may have. • Simple, easy meals that require minimal preparation are the key to success for an

overnight. • The majority rules, once the above issues have been addressed. • Make sure to practice all the “healthy cooking” concepts. • Divide the girls into smaller patrols makes the groups cooking more manageable. • Kaper chart• Small patrols can plan different meals for an overnight or plan a portion of the meals

for a day event. • Quantities to purchase• All of these are things to consider when cooking in a regular kitchen or on an

overnight with a stove and refrigerator at camp.

Pg 36

Food QuantitiesMeatsBacon 15-16 regular slices/poundBeef cubes1 lb./5 persons for stews; 1 lb. for 3 for shish kabobs Chicken 1-2 pieces/personSliced sandwich meat 16 slices/poundHamburger¼ lb./personHot dogs 10/pound; 1-2 per personBreadsRegular loaf 16-20 slicesLarge loaf 22-24 slicesPancake mix 1c/ 4 personsCornbread and similar mixes 1 box/ 8 personsGraham crackers 3 pkgs of 11 double crackers eachDairyEggs 1 ½ per person for scrambled; 1 per person for French toastMilk ½ gallon for 8 peopleButter 16 servings per ¼ poundCheese 1 lb. American = 4 c gratedCocoa 1 lb. = 100 cCanned goods#10 cans serve 30 people#5 cans serve 10 people8-10 oz. soup can serves 2 peopleSpaghetti and Macaroni1 lb. package serves 7-8 people (2/3 c each)Fruits and VegetablesPotatoes 1/personLettuce for salad 2 heads for 8 peopleCelery 2 bunches for 10 peopleTomatoes 1 for 2 people

Pg 37

Patrol Planner

MEAL 1 MEAL 2 MEAL 3 MEAL 4

Menu: Menu: Menu: Menu:

Shopping List: Shopping List: Shopping List: Shopping List:

Equipment List: Equipment List: Equipment List: Equipment List:

PATROL PLANNERPatrol Leader __________________________ Patrol Name _________________________Assistant Leader _______________________

Pg 37

Kaper ChartsWhy use kaper charts:• Helps with troop/group management,• Girls know what has to be done and when• Responsibility of a successful outing on the girls• A kaper chart is a fair way to distribute housekeeping duties• Girls learn to work together to accomplish a goal

Kaper charts can be very versatile. Some things to think about when planning:• Adult supervision varies with the grade level and maturity of the girls.• Allowing the girls to do the jobs with supervision means that by the time they are

Juniors, the volunteer will just need to do spot checks and as Cadettes, they will not need supervision.

• Kaper charts for different purposes on the same trip.• Every girl gets a turn at a Kaper.• Detailed descriptions of jobs on the kaper chart

• For example: Clean-up – wipe/wash table, put away extra food, sweep floor, wash troop/group equipment, etc.

Pg 38

No Cook S’Mores• Graham Cracker

Crumbs• Marshmallows• Chocolate Syrup

• Graham Cracker• Marshmallow fluff• Chocolate Chips

Evaluations• What did the girls like?

• What did the girls dislike?

• Next time?• How could we have handled a trying situation

differently?• What we should have brought?

OEGS pg 147-148

Pg 41

Facilitator Information

• Sabrina LeMay• 512-567-3073• slemay1@austin.rr.com