High-Risk Activity Council Approval Form When planning activities and field trips it is important to follow all Safety Activity Checkpoints for your chosen activity. In addition to following Safety Activity Checkpoints, the following activities listed in this form require council approval. Please complete this form at least two weeks prior to your activity and/or event, or as soon as you begin your activity planning. Name:* First Last Volunteer Role:*Email Address:* Is this for a troop or Service Unit event?*Troop EventService Unit EventTroop Number:*Service Unit Number:*Use the service unit directory if you're not sure.Grade level of girls participating:*Check all that apply. Brownie Junior Cadette Senior Ambassador Which activity is your troop participating in?*Check all that apply. Air/BB Guns Muzzle Loading Pistol Rifle Shotgun – trap/skeet shooting How many girls will be participating?*How many adults will be participating?*Date you will be participating in the activity?* Date Format: MM slash DD slash YYYY Are there additional dates you will be participating in the activity?*NoYesPlease list any additional dates you will be participating in the activity:* Click the (+) button to add an additional date. Please use mm/dd/yyyy format.What is the location where your activity is taking place?*If you are participating in the activity through a business, group, or certified professional, list them here:Click the (+) button to add an additional business, group or certified professional. Do the activity instructor/facilitator/leaders have the required certifications and/or license(s) as listed in Safety Activity Checkpoints?*YesNoPlease list the certification that the activity instructor/facilitator/leaders have completed.*What is the expiration date of the certification listed above?(if applicable) Date Format: MM slash DD slash YYYY I have read, understand, and will follow all rules and guidelines listed in the Safety Activity Checkpoint for our chosen activity. As the volunteer overseeing this troop activity, I understand it is my responsibility to ensure Safety Activity Checkpoints are followed.* Yes, I agree and accept these terms.