SWISS SPLENDOUR: GENEVA'S CUTLURE + ALPINE ESCAPE APPLICATION FORM

Before you start this application:

Check the expiry date on your passport. it must not expire within 6 months of the return date of this trip.
You will need two referees for this application - one Girl Guide member and one non-guiding person to provide a character reference for you. Contact them to check they are happy to fill out the online reference form generated once you complete this form.
It is your responsibility to follow up with your referees to ensure they complete their section of the form using the link emailed to them. The process does not proceed to the next step until each person hits submit!

Please read Privacy Collection Statement for Girl Guide Members. See link below.

Privacy Policy Collection Statements - Guide Lines - For Girl Guides and Girl Guide Volunteers

Applicant Details

First Name *

Middle Name

Last Name *

Preferred Name

Date of Birth *

Phone Number

Email *

Check your inbox and follow the instructions to verify your email.

Send code

Country *

Street address *

City *

State *

Postcode *

Tick this box to provide a different postal address.

Postal Street address *

Postal City *

Postal State *

Postal Address Postcode *

Membership Details

Event Name

SC Email

SGGO Email Address

National Checks Email

State Girl Guide Organisation *

Membership Number

Expiry Date

Please provide detail

Have you completed CPR training within the last 12 month?

Yes No

Are you interested in discussing a Contingent Leader role on this trip? (if applicable)

Yes NoMaybe

Motivation + Experience

Why are you applying for this trip or event?

What do you hope to gain from the experience?

List any external qualifications you hold or skills you have that are relevant to this application

Have you received any awards as an Adult Member?

Please tell us about your most recent international or major event experiencePlease include details of any roles you held.

Please provide more details

Please provide details

Emergency Contact

This person must be available as an emergency contact for the duration of the event/trip and not attending this event.

It is important to notify them that they are your emergency contact.

First Name

Last Name

Best Phone Number

Alternate Phone Number

Email Address

Please confirm email

Girl Guide Reference

Provide contact details for a Girl Guide Adult Member who can provide a reference for you.

Please contact this person to let them know the email is coming and to check their junk mail.

First Name

Last Name

SGGO *

What is their role in Girl Guiding?

Phone Number

Email Address *

Please confirm email address

Character Reference

Please provide details for someone willing to provide a personal reference/recommendation for you.

Please notify the person before submitting this application.

They will be sent an email with a link to a short form and should check junk mail for a snapforms email.

First Name

Last Name

Phone Number

Email Address *

Travel Details

Name as on Passport

Passport Number

Passport Expiry DatePlease note: the passport must not expire less than 6 months before the trip begins.

Visa Details (if required)

Health and Wellbeing

The information provided in this section will only be shared where deemed absolutely necessary.

Travelling overseas on new adventures and sharing accommodation is exciting but can be stressful. Providing the right information can be the key to a positive experience.

Pre-existing medical conditions: If you do not declare pre-existing medical conditions, the GGA insurance policy could be invalid. If your condition changes before the trip, you must tell the GGA Office.

Travellers with chronic(ongoing for 6 months or more) or complex conditions,must provide a GP care management plan or action plan.

A GP care management plan is a written plan of action that identifies your health and care needs, sets out services to be provided by your GP, and lists the actions you can take to help manage your condition.

This applies to all ongoing conditions such asthma, anaphylaxis, anxiety, adhd, diabetes, heart conditions etc; anything that you manage on an ongoing basis.

Speak to your doctor about including a plan for back up medication and medical devices, spare scripts, considerations for managing conditions while travelling and a plan for accessing support.

Health information

Do you have any illnesses, disabilities or any pre-existing medical conditions* that may affect you while you are taking part in this event/activity?

YesNo

* Pre-existing medical conditions: If you become unwell on the trip due to a pre-existing medical condition, the GGA insurance policy could be invalid if you haven't shared all the key information about your health with GGA.

Please provide details Name of condition, how it affects you, triggers and medications etc

Are you currently receiving any medical treatment?

Yes No

Please provide details

If you have a Care Plan/GP Care Management Plan please upload it here.

Browse

Please attach your care management and/or action plan/s.

Medications

Are you currently taking any prescription medications?

YesNo

Including adrenaline auto-injectors e.g. epi-pen, asthma inhalers etc

Please provide details Please list and detail any medications required. Visit the Smart Traveller website to read about taking medications overseas.

Are you currently taking any non-prescription medication (e.g. painkillers, eye drops, homeopathic remedies, sleeping aids etc)?

Yes No

This is important in the event that you need emergency care.

Please provide details

Allergies and dietary requirements

Do you have any allergies or sensitivities (e.g. to medicines, foods etc)?

YesNo

Please provide additional details.

Do you have any special dietary requirements?

YesNo

Please provide additional details.

Consent

I consent to having any medical, surgical or dental treatment, including anaesthetic, medical professionals considered necessary if I am involved in an incident/accident on the trip.

I confirm that the information given here is true and correct. I will notify the GGA Operations Manager if there are any changes to my medical situation before the trip takes place. I understand that if any information I have given is found to be inaccurate, it may stop me going on the trip.

Acceptance of Terms and Conditions

I confirm that I have read the International Travel Terms and Conditions - Girl Guides Australia and information provided in the application is correct. *

I accept the financial responsibility for this event, and agree to pay each payment on or before the due date. *

I confirm that I have read and agree with the Privacy Policy Collection Statements

*

I agree that I am responsible for notifying Girl Guides Australia about any changes to my health information that is relevant to my participation in this trip. *

I consent to my photo being published on Girl Guides Australia social media or promotional materials.

I do not consent to my photo being published on Girl Guides Australia social media or promotional materials.

I consent to my personal information being used to complete airline and other travel bookings on my behalf. *

I agree that if I miss any of my departure flights it is at the sole discretion of GGA whether or not I can rejoin the contingent. If it is determined that I cannot rejoin the contingent I acknowledge there will be no refund. *

Girl Guiding Reference

Applicant First Name

Applicant Last Name

First Name

Last Name

How do you know the applicant?

Have you directly observed the applicant around young people age 12-17 or 18-30? Please give more detail.

Children and young people are vulnerable, particularly to the adults working closely with them. Do you think the applicant is well suited to working with young people and why? 

How well does the applicant work with others and in a team. Please provide examples.

Please describe your experience of the applicant with respect to the way she approaches taking risks and her willingness to follow policies and procedures.

Describe any experience with the applicant with respect to her ability to speak up about concerns she may have about the behaviour of others. 

What would you say are her communication strengths and weaknesses?

Can you talk to her organisational skills and ability to meet deadlines? 

Based on your knowledge of the applicant, do you have any concerns about the applicant working under pressure with others, especially in the context of being responsible for young people they do not know for extended periods of time whilst overseas?  

Do you have anything to add which you think we should be aware of in relation to this applicant becoming a member of an overseas contingent? 

Please check this box if there’s anything important you need to add to the reference. The National Coordinator International will follow up with a phone call.

Your Signature

Clear

Date

Character/Personal Reference

Applicant First Name

Applicant Last Name

First Name

Middle Name

Last Name

In what capacity do you know the applicant?

Have you directly observed the applicant around young people age 12- 17 or 18-30? Please give more detail.

Children and young people are vulnerable, particularly to the adults working closely with them. Do you think the applicant is well suited to working with young people and why? 

How well does the applicant work with others and in a team. Please provide examples.

Please describe your experience of the applicant with respect to the way she approaches taking risks and her willingness to follow policies and procedures. 

Describe any experience with the applicant with respect to her ability to speak up about concerns she may have about the behaviour of others. 

What would you say are her communication strengths and weaknesses?

Can you talk to her organisational skills and ability to meet deadlines?

Based on your knowledge of the applicant, do you have any concerns about the applicant working under pressure with others, especially in the context of being responsible for young people they do not know for extended periods of time whilst overseas? 

Do you have anything to add which you think we should be aware of in relation to this applicant becoming a member of an overseas contingent? 

Please check this box if there’s anything important you need to add to the reference. The National Coordinator International will follow up with a phone call.

Your Signature

Clear

Date

Application Denial

I need to deny this application *

NoYes

Please provide reasons for this denialPlease detail your valid reason for denying this application at this stage.

You confirm that by submitting this form with this box checked, the workflow will stop and no additional automatic notifications will be provided at this stage. You must notify the GGA National Coordinator International that you've taken this action. She will make contact with the applicant to notify them.

You must tick this box to deny the application.

Signature

Clear

Date

SGGO Checks

Additional comments

Name of person completing checks

Date

State Commissioner

Are there any incidents recorded for this member which may impact their participation on this trip?

Yes No

Please provide details

I confirm I have reviewed this application and there are no reasons I am aware of that they are not suitable to take part in this event as a representative of Girl Guides Australia.

SC Signature

Clear

Date

National Checks

I confirm I have reviewed this application.

Was a call to a referee required?

YesNo

Please input your notes from the call here

Was an interview with the applicant required?

YesNo

Please input your notes from the interview here

Signature

Clear

Date

Pre-Trip Checks by SGGO

Please refer to SGGO records to complete this section and confirm this traveller's membership details.

Does this person meet all membership requirements for Girl Guiding in Australia? *

YesNo

For more information visit GuideLines Child Safe Child Friendly Framework

Please provide more details

Is any membership requirement due to expire or change within the next 3 months?

Yes No

E.G. Expiry of membership or CSCF Checks

Please provide specific details and dates here

Does the information provided relating to event/outdoor experience match SGGO records?

YesNo

Please provide more details

Do they hold a current First Aid accreditation?

YesNo

Traveller Pre-Trip Declaration

Please do a final check of your information and update it if needed.

I confirm that the information given here is true and correct:

Passport detailsHealth and wellbeing informationEmergency contact

Do you need to update any of the health and wellbeing information provided in original application?

YesNo

I acknowledge that managing and taking my prescribed medications is my personal responsibility.

I understand that I am responsible for discussing my care management plan/health condition action plan and any adjustments/ support I will need while on this trip with my doctor/s. It is my responsibility to provide a copy to GGA.

I confirm that I have read and accept the terms and conditions from the event organisers and Girl Guides Australia.

I confirm that I have read and accept the terms and conditions for this trip/event.

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