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TRIP APPLICATION FORM Girl Member Event applying for:

Part A. Personal information Name:

Last name First name

Birth date:
Year/Month/Date

iMIS number:

Address:
No. City Street Apt. No. P.O. Box or R. R. No. Province /Territory Postal Code

Phone:

Home Cell

( (

) )

Other

Email Address: Unit: Guiding Area/Community of Guiding(Ontario): Number of years of GGC Membership:

Part B. Participant Agreement I understand that by submitting this application and if selected, GGC will be making a significant financial contribution for my participation in this event. In light of that: a. I will prepare for this international experience as required. b. I will positively represent Girl Guides of Canada-Guides du Canada to all persons I meet throughout this international experience. c. I understand that I will be expected to share my experiences within GGC, as may be further specified, upon my return to Canada. d. I agree to be an active Member of GGC for a minimum of one year following the trip. If I do not do so, I agree that I will reimburse GGC for 50% of the actual subsidy for this event. e. I agree to all the items outlined on the General Qualification Guidelines for International Events.

Applicants name Applicants signature Date

Note: In order that as many Members as possible have the opportunity to participate in nationally- sponsored international events, Members selected may participate in these events as follows: Once as a girl Once as a young adult (the young adult category is usually between the ages of 18 and 25, but may vary) Once as an adult

Revised August 2010 (Replaces form dated 2008/09/19 Revised 2009/06) Event + 1 yr (A); Event + 3 yrs (D)

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Part C. Permission and guarantee of financial responsibility
Permission is hereby granted for: To attend:
If applicant is applying for more than one event, please list events

Parent/Guardians name

Parent/Guardians signature

Date

Address (if different from participants)

No. City Street Apt. No. P.O. Box or R. R. No. Province/Territory Postal Code

Phone:

Email:

Financial responsibility for costs over and above that given by Girl Guides of Canada-Guides du Canada will be guaranteed by:
Name Signature Date

Address (if different from above)

No. Street Apt. No. P.O. Box or R. R. No.

Note: Girl Members are encouraged to fundraise for the remainder of their trip costs. Please refer to GGCs fundraising guidelines, available at https://memberzone.girlguides.ca/C4/FundDevelopment/Document%20Library/Fundraising%20Guidelines.pdf

Part D. References Please provide the name and contact information for your two references. Within Guiding: Name:
Last name First name

Phone:

Email:

Outside of Guiding: Name:

Last name First name

Phone:

Email:

Revised August 2010 (Replaces form dated 2008/09/19 Revised 2009/06) Event + 1 yr (A); Event + 3 yrs (D)

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Part E. Self-evaluation Please answer honestly how true each of the following statements is for you: (Check only one box per statement). Not like me Somewhat Very much at all like me like me I adapt easily to different situations I am able to follow directions I am a good problem solver I get along well with my peers I get along well with adults I am considerate of others I am tolerant of peoples differences I am open to new situations and ideas I like to be challenged I am reliable I am emotionally mature I am comfortable being away from my family I deal well with changes in plans I am active I am honest I am knowledgeable about Girl Guides of Canada I am knowledgeable about the World Association of Girl Guides and Girl Scouts (WAGGGS)

Exactly like me

In 200 words or less, please provide examples or explanations of your responses.

Revised August 2010 (Replaces form dated 2008/09/19 Revised 2009/06) Event + 1 yr (A); Event + 3 yrs (D)

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Part F. Relevant Experience 1. Have you spent time away from your family? If yes: How long did you spend away? Where did you go? Who did you go with? 2. Do you meet all of the physical requirements of the particular trip you are applying for (e.g. ability to hike, swim, etc.)? See the trip fact sheet. Yes No Please give examples of how you meet the requirements: Yes No

3. If camping is involved, please answer the following: Do you have camping experience? Yes No If yes, What types of camps have you attended?

What is the length of the longest camp you attended?

What specialized skills and/or new experiences have you gained from camps you attended?

Describe one or two of your favourite camps and explain why they were your favourites.

Revised August 2010 (Replaces form dated 2008/09/19 Revised 2009/06) Event + 1 yr (A); Event + 3 yrs (D)

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If this will be your first camping experience, what specialized skills and/or new experiences do you expect to gain?

Part G. Trip interest In 600 words or less, explain: Why this trip in particular interests you What specific knowledge and skills you would bring to the group which would make you a great participant What you expect to learn from this experience How you can use the experience to enhance the Guiding program Please do not submit resumes or copies of certificates, diplomas, pictures, graphics, etc. Use a separate sheet if necessary

We protect and respect your privacy. Your personal information is used only for the purposes stated on or indicated by the form. For complete details, see our Privacy Statement at www.girlguides.ca or contact your provincial office or the national office for a copy.
Revised August 2010 (Replaces form dated 2008/09/19 Revised 2009/06) Event + 1 yr (A); Event + 3 yrs (D) Page 5 of 5