Girl Scouts of Washington Rock Council, Inc.
201 Grove Street East, Westfield, NJ 07090
908-232-3236
Name of Company________________________________________________________________________
Address_________________________________________________________________________
Company Contact Person _____________________________________Phone_________________
This is to confirm the arrangement made for troop/group #_________________________________
By______________________________________________________________________________
Adult in charge
position
phone
Departing from___________________________________________________________________
Location
date
time
To arrive at ______________________________________________________________________
Location
date
time
Returning from___________________________________________________________________
Location
date
time
To arrive at ______________________________________________________________________
Location
date
time
# Passengers ___________________ ____________________ # vehicles ______________
Girls
adults
Type of Vehicle _____school bus _____car
_____Coach bus _____passenger van
_____ Other ____________________________
Girl Scout Emergency Contact Person
Name__________________________________________________Phone____________________
The Girl Scouts of Washington Rock Council requires that a copy of the Certificate of Insurance from your company be on file in our office prior to the date of service. Please sign all three copies and return to the Council Service Center at the above address. One copy of the agreement will be signed and returned to you.
Girl Scout Adult________________________________________________________________________
Date
Charter Company Representative___________________________________________________________
Date
GSWR Council Executive Director_________________________________________________________
Date