Health + Safety

Forms for Participants

• Health History Form
  Documents activities members should not participate in and authorizes first aid and emergency transport to a healthcare facility.
• Parent/Guardian Permission Form
• Medication Information Form
  Documents medication information and permission to dispense.

Safety Guidelines

• Safety Activity Checkpoints
  Comprehensive safety guidelines for all activities, programs and events.
• Safety-Wise
  This section of Volunteer Essentials outlines safety rules and procedures for volunteers to keep girls safe

Incident Report + Claim Forms

• Mutual of Omaha Claim Form
  Activity incident insurance claim form.
• Mutual of Omaha Claim Form – Spanish
  Activity incident insurance claim form.
• Mutual of Omaha Fraud Statement
• How to file a claim
• Accident Incident Report
  Complete this form within 24 hours of an accident/incident.
• Mutual of Omaha website for Girl Scouts

Insurance Information + Enrollment Forms

• Mutual of Omaha Instructions
  Use to determine which plan you should purchase for your outing or trip.
• Sample Enrollment Form
  Review to make sure all information has been included prior to submitting your enrollment to the council.
• Plan 2 Enrollment Form
  Member and non-member accident insurance.
• Plan 3E Enrollment Form
  Member and non-member accident and sickness insurance.
• Plan 3P Enrollment Form
  Member and non-member accident and sickness insurance.
• Plan 3PI International Trip Enrollment Form
  Member and non-member accident and sickness insurance for international trips.
• Trip Roster
  Complete and submit with all 3PI (International Trip) Enrollment Plans.

Crisis Report + Form

• Crisis and Safety Management Report