Supplemental Insurance Request Form All current Girl Scout members are automatically covered under a basic activity accident insurance plan. This plan covers registered members for supervised Girl Scout activities lasting two consecutive nights or less. It allows members to recoup any out-of-pocket expenses from an accident that may have taken place during an approved Girl Scouts Activity. If you are coordinating an event in which non-members are attending, please request the accident insurance to cover them as well. If you are planning a Girl Scout activity that will last longer than two consecutive nights—like a troop trip—please fill out the Supplemental Insurance Request Form below for extra coverage of both members and non-members. This covers out-of-pocket expense for both accidents and illnesses. Service Unit Day Camps do not need to request supplemental insurance. It is automatically purchased once the day camp application has been approved by Girl Scouts River Valleys. Girl Scouts River Valleys will use this information to purchase additional insurance coverage on your behalf. Girl Scouts River Valleys must receive this form at least one month prior to your activity to be able to process. Please Note: If an organization or property owner that you are working with requests proof of insurance, what they are requesting is a Certificate of Insurance (COI). Use the Certificate of Insurance Request Form for those requests.Type of Activity* Service Unit or Troop Event Travel within the United States International Travel Your Name* First Last Email Address* Troop Number or Service Unit Number* To look up your service unit name or number, see our service unit directory.Event DetailsName of Event* Location* Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Number of Non-Member Participants*Travel InformationDestination City* Destination State*Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMainMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNabraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingTraveler(s) Information*First NameLast NameAge at time of travel Click the (+) button to add an additional traveler.Total Number of Travelers*Destination City/Town* Destination Country* Departure Date* MM slash DD slash YYYY Return Date* MM slash DD slash YYYY Total Number of Travelers*
