girl scouts
of northern california

Please refer to the updated coviD-19 guidelines on the GsNorCal website. These guidelines are consistent with the state of

California's new protocols that went into effect on March 12, 2022, and provide information on practices associated with the
wearing of masks, appropriate social distancing, camping, the serving of food and drink, carpooling, and domestic and
international travel. By allowing your child to participate in Girl Scout activities and events: a) you acknowledge that an inherent
risk of exposure to coviD-19 exists for any in-person activity, including meetings, activities, events, and trips; and b) you are

voluntarily assuming all risks related to exposure to COviD-19 and agree not to hold Girl Scouts of Northern California, or any of
its directors, employees, agents or volunteers, liable for any illness or injury.

Parents/Guardians keep the top portion of this form.Return the bottom portion to the Troop Leader.

In case of an emergency, the following person will immediately notify the parents:
Emergency Contact for the Event:

RETURN THIS PORTION TO TROOP LEADER

Name of Girl Scout:
Event Name:

The above-mentioned Girl Scout is in good physical condition and has not had any serious illness or surgery since her last health examination. I hereby give my
consent for my girl member to be tested for the coviD-19 virus while participating at this in-person Girl Scout activity or event by the event First Aider, using a
simple over the counter test, should the First Aider suspect possible exposure based on participant health. I give permission for her to receive emergency
medical or surgical treatment and to be hospitalized, if necessary. It is understood that every attempt will be made to contact me, or the emergency contact
person listed below, before taking this action. During the activity, I can be reached at:

Additional Remarks:
Girl Scouts of Northern Californiagsnorcal.org800.447.4475info@gsnorcal.org |March 2022

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Activity/Event Permission Form

Troop Number:Name of Event, Trip, or Activity:Date:Time:Cost for Event:Items to bring:Items NOT to bring:Arrangements for TransportationDeparture Time:Mode of Transportation:Return Time:Mode of Transportation:Adult Volunteers Accompanying the GirlsAdult Volunteer 1:Adult Volunteer 2:

Name of Location:Address:Phone:Departure Place:Return Place:

Website:Phone:Phone:

Phone:

Troop #:

Name of Parent/Guardian:Signature:If I cannot be reached in the event of an emergency, the following person is authorized to act on my behalfMedical ContactEmergency Contact Name

Phone:Date: Phone:Phone:

Relationship to Child:Physician's Name:

Email:

 

Waiver, Assumption of Risk and Indemnity for Private Property Rentals

My Girl Scout member is participating in a Girl Scout activity that includes plans to stay in one or more private rental
properties, either rented directly through a private owner and/or rented through a short-term rental platform such as

Airbnb, VRBO or HomeAway (collectively, "Private Rental Properties"). I understand that there are known, and unknown
risks associated with Private Rental Properties and understand and am aware that neither Girls Scouts of the UsA, nor Girl
Scouts of Northern California, conducts screening of nor assumes any responsibility for Private Rental Properties. Such

risks include,and are not limited to:
Unsafe conditions, including physical and fire safety and lack of support in an emergency;

Security concerns, including hidden cameras, and break-ins;

Failure to comply with local laws applicable to short-term rentals

Issues with the property owner/host, including last minute cancellations, no refunds, photos don't match reality,
bait and switch from rented accommodation to an inferior accommodation; and

Lack of insurance coverage for claims and injuries arising out of the rental.

Waiver. In return for being permitted to participate in Girl Scout activities at Private Rental Properties, I, for myself, heirs.
personal representatives, and assigns, assume all risks and release, waive, and discharge, Girl Scouts of the UsA, Girl
Scouts of Northern California, and/or any of their directors, officers, employees and agents ("Girl Scouts'), from liability
from any and all claims, resulting in personal injury (including death), accidents or illnesses, in connection with our troop's
rental, use, and/or enjoyment of one or more Private Rental Properties for Girl Scout activities.

Acknowledgement of Risks and Responsibilities Related to Private Rentals, including through short-term rental

platforms. I have read and understand, and agree to adhere to, the Volunteer Essentials and Safety Activity Checkpoints
for Private Property Rentals, including through short-term rental platforms, such as Airbnb, VRBo, HomeAway, including,

but not limited to, the obligations to inform participants and required forms to assume risk and hold harmless GsNorCal.

I have read this Waiver, Assumption of Risk and Indemnity for Private Property Rentals document, fully understand its
terms, including, that I am assuming all risks of renting and/or using Private Rental properties, and, with respect to any
such rentals, use, and/or enjoyment am: (a) releasing Girl Scouts from all liability, (b) waiving any right to sue my right to
sue Girl Scouts, and (c) indemnifying Girl Scouts.I further agree that if any portion of this Waiver, Assumption of Risk and
Indemnity is held to be invalid, the remaining portions will continue to have full legal force and effect.

Name of Participant:

Parent Signature:
Print Name:

Girl Scouts of Northern Californiagsnorcal.org800.447.4475info@gsnorcal.org |March 2022

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Participant Date of Birth:

Date: