PLANNED ACTIVITIES (check all that apply):
Archery
3
Rafting/White-Water Rafting
2
Backpacking
3
Scuba Diving
2
Boating/Sailing
2
Segway
3
Canoeing/Kayaking
2
Shooting Sports
3
Challenge Course/Climbing & Rappelling/Ziplining
3
Skateboarding
3
Fencing
3
Snow Skiing, Sledding, Tobogganing, Tubing
3
Hayrides
4
Snorkeling
2
Horseback Riding or Vaulting on Horseback
3
Spelunking
3
Indoor Skydiving
3
Standup Paddleboarding
2
Indoor Trapoline Parks
3
Surfing
2
Overnight with Camping
1
Swimming
2
Overnight without Camping
Tubing/Water Skiing/Wakeboarding
2
Parades and Other Large Group Gatherings
4
Windsurfing
2
Pedal Boating
2
Numbered activities require trained and/or certified personnel. Refer to boxes 1, 2 or 3 and Form #571T.
1. TROOP CAMPER (Required for camping activities)
3. OTHER SPECIALIZED PERSONNEL
Name: ___________________________________________
Name ___________________________________________
SITE ORIENTATION (Required if using council campsite)
Certification Type*________________________________
Name: ___________________________________________
Expiration Date
________________________________
2. WATERFRONT ACTIVITIES (Specify Type)
* Documented experience may replace certification, but a copy
.
Swimming Pool
Waterpark
Lake River
of the documentation must be provided.
Other _________________________________________
Personnel provided by: Facility
Service Unit
4. COMMUNITY EVENTS
Troop (Fill in information below):
Name of Event: ____________________________________
Lifeguard Name __________________________________
In detail, describe how the troop plans to participate (i.e. – march
Certification Type & Expiration Date _________________
or ride on a float in a parade, provide a service booth at a town
Canoe Instructor __________________________________
carnival, etc): ________________________________________
Certification Type & Expiration Date _________________
Other (Specify): ___________________________________
Name ___________________________________________
Certification Type & Expiration Date _________________
Refer to Safety Activity Checkpoints for Parades and Other Large
Please list names of adults serving as watchers. The troop is
Group Gatherings which includes a paragraph pertaining to
responsible for watchers:
appropriate plans for parade floats. If renting, leasing or
_______________________
________________________
borrowing a vehicle, Form #589F must be attached to this
_______________________
________________________
request. NOTE: The term “vehicle” refers to trailers or other
towed conveyances as well as to motorized carriers.
Charge Campsite Use Fee of $__________ to:
YOU DO NOT NEED COUNCIL APPROVAL IF THE TROOP
IS ATTENDING THE EVENT AS SPECTATORS.
Account # _________________________________________
VISA
MasterCard
Other ___________________
HAYRIDES
Name on Card ______________________________________
Refer to Safety Activity Checkpoints for Hayrides. The State of
Expiration Date: Month __________ Year __________
Oklahoma does not require a hauled vehicle to be licensed or to
CVV (3-Digit Code on Back of Card) _____ _____ _____
display a safety inspection sticker if it is not used commercially.
Billing Zip Code _______________
Therefore, it is the responsibility of the leader to insure that these
guidelines are being met.
FOR OFFICE USE ONLY
Date
APPROVED __________
DENIED __________
Comments: _________________________________________________________________
Date Received ______________
Use Fee Paid $______________
Receipt #
______________
#585F 06/16