Facilitated Outdoor Program Request Form

General Contact Information

THIS FORM IS CURRENTLY UNDER CONSTRUCTION. PLEASE EMAIL KARA KASTENHOLZ IN THE MEANTIME IF YOU WOULD LIKE TO REQUEST A PRIVATE FACILITATED OUTDOOR PROGRAM FOR YOUR GROUP. PLEASE NOTE THAT GROUPS MUST HAVE A MINIMUM OF 16 PEOPLE TO RUN A PROGRAM.

KKASTENHOLZ@GIRLSCOUTSGCNWI.ORG

PLEASE NOTE: DO NOT FILL OUT THIS FORM RIGHT NOW. PLEASE EMAIL THE EMAIL ABOVE IF YOU WOULD LIKE TO DISCUSS SETTING UP A FACILITATED OUTDOOR PROGRAM.

Welcome!

We hope you are as excited about your potential facilitated outdoor program as we are. To help us get started in planning your program please answer the questions below. A member of the Outdoor Program Team will follow up with you to let you know if we can honor your request or not. We cannot place programs with less than 6 weeks notice. For groups larger than 35, requests must be made at least 8 weeks in advance.

Please note that completion of this request form is not a guarantee that we will be able to facilitate an outdoor program for your troop/group.

Please double check this information for accuracy, as this is what we will use to contact you moving forward.

First Name *

Last Name *

Group's Name *

Group's Troop or Service Unit Number

Group's City *

Group's State *

Zip Code *

Email Address *

Primary Phone Number *

Secondary Phone Number *

Will there be a secondary contact for this group? *

Yes

No

Secondary Contact Information

Secondary First Name *

Secondary Last Name *

Secondary Group's Name (if different from primary) *

Secondary Primary Phone Number *

Secondary Phone Number *

Secondary Email Address *

Program Size

Please note that facilitated outdoor programs must have a minimum of 16 participants, including children and adults.

Is this program request for a small or large group? *

Single troop

A couple troops (2)

More than 2 troops, but not an entire service unit

An entire service unit

A non-Girl Scout group A non-Girl Scout group

How many girls do you think you will have attending? *

What is/are the Girl Scout level(s) of the youth participants?
(check all that apply) *

What grade(s) will your group be at time of your requested program? (For programs occurring before June 1, 2024 this is the grade the Girl Scout is in for the 2023-2024 school year. For programs after June 1, it is the grade they are in for 2024-2025 school year.) *

How many adults do you think you will be attending? (At minimum, groups need to meet adult to girl ratios outlined in the Girl Scout Safety Activity Checkpoints.) *

Will siblings or other non-Girl Scout children be invited to your event? *

Yes

No

How many other, non-Girl Scout, children do you anticipate attending? *

Will there be any males in your group? If so, how many do you expect and are they adults or kids? *

If your group falls short of the minimum of 16 participants (children and adults), are you willing to combine your program with another troop and/or still pay for 16 spots? *

Yes

No

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Eight Grade	Ninth Grade	Tenth Grade	Eleventh Grade
Twelfth Grade Twelfth Grade