Troop Trip/Activity Alert
This form is for use by the Chester and Auburn, NH Service Units ONLY
Fill out and submit this form to the Service Unit Manager TWO WEEKS prior to trip or sensitive activity.

Your Email Address:
Todays Date: (mm/dd/yy)
Troop Number: Level: (DA, BR, JR, CD, SR, AM)
# of Girls: # of Adults:
Troop Leader Name:
Date of Trip: (mm/dd/yy) Alternate date of Trip:

For sensitive activity:       Parental Permissions were distributed on: (mm/dd/yy)

For Trip:

Time & Place of Departure:



Return:
Approx. round trip mileage: Estimated total hours on trip:
Specific Destination:
Address (street, city, state):
Phone:
Purpose:
Adult Driver #1 Info:
Adult Driver #2 Info:
Adult Driver #3 Info:
Adult Driver #4 Info:

Group Emergency Contact Name:
Phone:
Your emergency contact person is someone who is NOT attending
the trip and has all the girl's contact information. In the event of an
emergency, you can call this person and he or she can notify the
parents. Your emergency contact can not be the leader if she is
attending the trip.

First Aid/CPR Person:
Dates of Expiration: CPR: (mm/dd/yy) First Aid
If trip requires (Check Safety-Wise)
Names of:
Basic or Advanced Outdoor Living Trained Person: Expires: Does Not Expire
A person attending any trip that involves camping, hiking, cooking outdoors or sleeping outdoors (even in your back yard) must be trained in Basic or Advanced Outdoor Living Skills (BOLS or AOLS).
Lifeguard: Expires:
Lifeguard is also required to hold "CPR for the Professional Rescuer": Expires:
Other: Expires: