Travel in Canada Participant ListUnit iMIS: ______

Instructions:

Please ask ALL participants (adults and parents/guardians) to provide you with the information you need to complete this form as follows:
PART A: For preauthorization, attach this form to the Travel Preauthorization (SG.8)
PART B: For final authorization, update and add information on where to contact participant’s relatives/parents/guardian during the trip. Attach to the Interprovincial Trip Authorization (SG.3)

Responsible Guider
Name : / iMIS#:
e-mail: / Phone #:
Unit:
Number of Adults: / Number of Girls:
Date of departure: / Date of return:
Places to be visited:
Home Contact
Name: / iMIS#: / Phone #:
e-mail: / Cell #:
Participants
Name / iMIS# / Date of Birth
(DD/MM/YYYY)
1. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)
2. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)
3. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)
4. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)
5. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)
Name / iMIS# / Date of Birth
(DD/MM/YYYY)
6. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)
7. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)
8. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)
9. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)
10. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)
11. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)
12. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)
13. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)
14. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)
15. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)
16. / Guider Girl
Primary Contact: / (H) / (C) / (W)
Second Contact: / (H) / (C) / (W)

Girl Guides of Canada, Ontario Council

Revised May 2017

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