Girl Scouts Heart of New Jersey                                                                                                                                                             Troop/Service Unit Trip Roster 
     nt Coordinator Name:                                        Event Host (SU or Troop #)
                      Venue:                                            Departure Date:                             Return Date:
     Participants
                                                                                           Alternate Emergency  Currently 
                                           Guardian or Adult       Guardian or Adult  Contact Phone Number  Registere                            COVID Vax               Passed       CPR/1st       O&O1           O&O2         O&O3 
        Full Legal Name Girl or Adult?                                                                                              Troop #     or Negative Driver? Backgroun Aid Cert.  Attendance  Attendance Attendanc
                                                    E-mail Address    Phone Number          (must not be attending        d                         Test?               d Check?        Date         Date          Date         e Date
                                                                                                    event)            Member?
     Sample Girl Smith            Girl     girlsmom@gmail.com           908-765-4321            973-999-4567             Yes         12345           Test
     Sample Adult Jones          Adult     mom@gmail.com                908-123-4567            201-123-9999             Yes         67890       Vax 10/5/21     Yes        Yes                    3/1/2016