1TOUR AND ACTIVITY PLANA national Learning for Life and Exploring Tour and Activity Plan is required for all posts/clubs/groups traveling to areas 500 miles or more one way from home area or crossing national bound-aries into the territory of other nations. This application should be submitted, typed or printed, to the local Learning for Life office for approval at least one month before your outing.

Date ____________________________ oPost oClub oGroup Unit No. _________ Participating organization ________________________________________

Council name/No. ________________________________________________/_______________

Description of tour or activity ______________________________________________________

From (city and state) ______________________________to _____________________________

Dates _________________________ to ________________________ Total days ____________

Itinerary: It is required that the following information be provided for each day of the tour. (Note: Speed or excessive daily mileage increases the possibility of accidents.) Attach an additional page if more space is required. Include detailed information on campsites, hotels, routes, and float plans, and include maps for wilderness travel as required by the local council.

DateTravel

Mileage Overnight stopping place (Check if reservations are cleared.) From To

Type of trip: oDay trip oShort-term outing (less than 72 hours) oOther ________________________________________________ oLong-term outing (longer than 72 hours) oHigh-adventure activities oHigh-adventure base____________________

Party will consist of (number):____ Youthmale ____ Youthfemale____ Adultsmale ____ Adultsfemale

Party will travel by (check all that apply):oCar oBus oTrain oPlane oVan oBoat oCanoeoFoot oCycle oOther _________________________________________

Leadership and Youth Protection Training: (Learning for Life policy requires at least two adult leaders on all overnight trips and tours. Coed units must have both male and female leaders.) The adult leader in charge of this unit must be at least 21 years old and have completed Learning for Life or Exploring Youth Protection Training.

Name of adult leader in charge _________________________________ Age _____ Position ________________ Registration Expires __________

Street or R.F.D. ___________________________________________________________________________________________________________

City ______________________________________________________ State ___________________________________ Zip code __________

Home Phone ______________________________________________ Business Phone ______________________________________________

List experience and training for this responsibility ______________________________________________________________________________

I have in my possession a copy of Learning for Life Safety First Guidelines and have read it. Adult leader signature ___________________________

At least one associate adult leader is required (minimum age 21).

Name ______________________________________ Age _____ Position ______________________________ Registration Expires ____________

Address ___________________________________________________________________________________ Phone ______________________

Name ______________________________________ Age _____ Position ______________________________ Registration Expires ____________

Address ___________________________________________________________________________________ Phone ______________________

Attach a list with additional names and information as outlined above.

If party will travel with another post, club, or group that has a male or female (circle one) leader, please list information below. This leader will be responsible for youth in post.

Advisor ___________________________________________________ Post No. ________ Council __________________________________

Signature: Post advisor/club sponsor or LFL representative Signature: Adult leader

Unit single point of contact (not on tour)

Name ____________________________________Phone __________________Email_________________________________________________

For office use

Tour and activity plan No. ____________

Date received _______________________

Date reviewed ______________________

Council stamp/signatures

2MAKE MODEL YEAR

NUM

BER

OF

SAFE

TY B

ELTS

DRIVER/OWNER

VALID DRIVERSLICENSE(Y or N)

LIABILITY INSURANCE COVERAGE

Combined Single Limit

Tour involves: oSwimming oBoating oClimbing oOrientation flights (attach Flying Plan required) oWilderness or backcountry (must carry Wilderness Use Policy and follow principles of Leave No Trace) oShooting oOther (specify) Activity Standards: Where swimming or boating is included in the program, Safe Swim Defense and/or Safety Afloat are to be followed. If climbing/rappelling is included, then Climb On Safely must be followed. At least one person must be current in CPR/AED from any recognized agency to meet Safety Afloat and Climb On Safely guidelines. At least one adult on an overnighter must have completed Exploring Basic. At least one adult must have completed Planning and Preparing for Hazardous Weather training for all tours and activities. Basic First Aid is recommended for all tours, and Wilderness First Aid is recommended for all backcountry tours.

Expiration date of trainings (two years from completion date)

Name Age Youth Protection

for Exploring or LFL

Planning and Preparing for

Hazardous Weather

Exploring Basic(no expiration)

Climb On Safely Safe Swim Defense

Safety Afloat

Name Age CPR Certification/Agency CPR Expiration Date

First-Aid Certification/Agency First Aid Expiration Date

Name Age NRA Instructor and/or RSO (check all that apply)

No. _______ oRifle o Shotgun oPistol (Venturing only) oRange Safety Officer oMuzzle-loading rifle oMuzzle-loading shotgun

No. _______ oRifle o Shotgun oPistol (Venturing only) oRange Safety Officer oMuzzle-loading rifle oMuzzle-loading shotgun

oOur travel equipment will include a first-aid kit and road emergency kit.oGroups/posts/clubs going into the wilderness or backcountry must carry and abide by the Wilderness Use Policy, available at your local

Learning for Life office.oThe group leader will have in his or her possession the appropriate health and medical forms for every adult and youth.Unauthorized and Restricted Activities: Learning for Lifes general liability insurance policy provides coverage for bodily injury or property damage that arises out of an official Learning for Life activity as defined by the Safety First Guidelines. Volunteers, units, participating organizations, and local councils that engage in unauthorized activities are jeopardizing their safety and insurance coverage. PLEASE DO NOT PUT YOURSELF AT RISK.INSURANCEAll vehicles MUST be covered by a liability and property damage insurance policy. The amount of this coverage must meet or exceed the insurance requirement of the state in which the vehicle is licensed and comply with or exceed the requirements of the country of destination for travel outside the United States. It is recommended, however, that coverage limits are a $100,000 combined single limit. Any vehicle designed to carry 10 or more passengers is required to have a $500,000 combined single limit. In the case of rented vehicles, the requirement of coverage limits can be met by combining the limits of personal coverage carried by the driver with coverage carried by the owner of the rented vehicle.

If the vehicle to be used is designed to carry more than 15 people (including the driver), the driver must have a valid commercial drivers license (CDL). In some states (California, for example), this policy applies to drivers of vehicles designed to carry 10 or more people.

All vehicles used in travel outside the United States must carry a public liability and property damage liability insurance policy that complies with or exceeds the requirements of that country. Attach an additional page if more space is required.

Name ___________________________________________________________ CDL expires ___________________________________________

Name ___________________________________________________________ CDL expires ___________________________________________

800-736 2014 Printing

Tour and activity plan No: Date received: Date reviewed: Date: Group1:

Unit No: Participating organization: Council nameNo: undefined: Description of tour or activity: From city and state: to: Dates: to_2: Total days: DateRow1: FromRow1: ToRow1: MileageRow1: Overnight stopping place Check if reservations are clearedRow1: Check Box2: 0: 1: 2: 3:

DateRow2: FromRow2: ToRow2: MileageRow2: Overnight stopping place Check if reservations are clearedRow2: DateRow3: FromRow3: ToRow3: MileageRow3: Overnight stopping place Check if reservations are clearedRow3: DateRow4: FromRow4: ToRow4: MileageRow4: Overnight stopping place Check if reservations are clearedRow4: Type of trip: 0: 0:

o Other: o Highadventure base: Party will consist of number: Youthmale: Car: Bus: Train: Plane: Van: Boat: Canoe: Foot: Cycle: o Other_2: Name of adult leader in charge: Age: Position: Expiration date: Street or RFD: City: State: Zip code: Home Phone: Business Phone: List experience and training for this responsibility: Name: Age_2: Position_2: Expiration date_2: Address: Phone: Name_2: Age_3: Position_3: Expiration date_3: Address_2: Phone_2: Advisor 1: Post No: Council: Name_3: Phone_3: Email: Adults female: Adults male: Swimming: Boating: Climbing: Orientation flights: Wilderness: Shooting: Other:

o Other specify: NameRow1: AgeRow1: Youth ProtectionRow1: Planning and Preparing for Hazardous WeatherRow1: Exploring Basic no expirationRow1: Climb On SafelyRow1: Safe Swim DefenseRow1: Safety AfloatRow1: NameRow2: AgeRow2: Youth ProtectionRow2: Planning and Preparing for Hazardous WeatherRow2: Exploring Basic no expirationRow2: Climb On SafelyRow2: Safe Swim DefenseRow2: Safety AfloatRow2: NameRow3: AgeRow3: Youth ProtectionRow3: Planning and Preparing for Hazardous WeatherRow3: Exploring Basic no expirationRow3: Climb On SafelyRow3: Safe Swim DefenseRow3: Safety AfloatRow3: NameRow4: AgeRow4: Youth ProtectionRow4: Planning and Preparing for Hazardous WeatherRow4: Exploring Basic no expirationRow4: Climb On SafelyRow4: Safe Swim DefenseRow4: Safety AfloatRow4: NameRow1_2: AgeRow1_2: CPR CertificationAgencyRow1: CPR Expiration DateRow1: FirstAid CertificationAgencyRow1: First Aid Expiration DateRow1: NameRow2_2: AgeRow2_2: CPR CertificationAgencyRow2: CPR Expiration DateRow2: FirstAid CertificationAgencyRow2: First Aid Expiration DateRow2: NameRow1_3: AgeRow1_3: undefined_3: Rifle: Shotgun: Pistol: Range Safety Officer: Muzzle-loading Rifle: Muzzle-loading Shotgun: NameRow2_3: AgeRow2_3: undefined_4: Rifle2: Shotgun2: Pistol2: Range Safety Officer2: Muzzle-loading Rifle2: Muzzle-loading Shotgun2: Check Box5: 0: 1: 2:

Name_4: CDL expires: Name_5: CDL expires_2: MAKERow1: MODELRow1: YEARRow1: NUMBER OF SAFETY BELTS1: 0:

DRIVEROWNERRow1: VALID DRIVERS LICENSE Y or NRow1: Combined Single LimitRow1: MAKERow2: MODELRow2: YEARRow2: NUMBER OF SAFETY BELTS2: DRIVEROWNERRow2: VALID DRIVERS LICENSE Y or NRow2: Combined Single LimitRow2: MAKERow3: MODELRow3: YEARRow3: NUMBER OF SAFETY BELTS3: DRIVEROWNERRow3: VALID DRIVERS LICENSE Y or NRow3: Combined Single LimitRow3: MAKERow4: MODELRow4: YEARRow4: NUMBER OF SAFETY BELTS4: DRIVEROWNERRow4: VALID DRIVERS LICENSE Y or NRow4: Combined Single LimitRow4: MAKERow5: MODELRow5: YEARRow5: NUMBER OF SAFETY BELTS5: DRIVEROWNERRow5: VALID DRIVERS LICENSE Y or NRow5: Combined Single LimitRow5: