Meeting in a Private Home Approval Form "*" indicates required fields When choosing a safe meeting space, consider the age range and type of activities you want to engage in when selecting a location or facility for your troop meetings. A meeting space needs to provide a safe, clean, and secure environment that allows for participation of all Girl Scouts members. For some troops this may mean meeting in a leader’s home. Girl Scouts does not recommend holding troop meetings in private homes. However, if you are considering meeting in a private home, remember to ensure the standards for compliance as described at the bottom of this form are met. We also recommend that you check with your homeowner’s insurance company to understand your liability and risk.CONTACT INFORMATIONName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Enter Email Confirm Email Phone*Troop Number*Please input five digits only. e.g. “00000”, “00001”, “00123”, “99999”. Service Unit*400 Rancho Foothills401 Alhambra/Rosemead/Santa Fe Trails402 Bonita403 Claremont404 Anita Oaks/Mission Camellias405 Chino406 Canon Trails407 CV/Glendale408 Pomona409 River Trails411 Upland412 La Canada414 Monrovia/Duarte415 Las Caballeras416 Puente Hills418 San Marino419 Glendora420 South Pasadena421 Covina Oaks422 West Covina425 Crown Poppy426 Mt. View427 Campo Verde428 Ontario/Montclair429 Gateway450 Chino Hills501 Compton/Lynwood502 Bellflower/Hollymount503 Belmont504 Lachen505 Holly Hills506 Highland Rose507 Lakewood508 Alamitos/Marina509 Westchester/Del Rey511 Culver City512 RDE/Sil-Dom513 Northeast Hills515 El Segundo516 East LA517 Southwest SU518 Center City519 Lawnthornes522 La Brea Heights524 King Harbor526 North Redondo528 Manhattan Beach529 South Bay Four533 Marina538 Pali/Mali540 San Pedro542 Santa Monica Bay543 S. Torrance545 Torrance546 PV/Penn601 Burbank604 Westside605 Rancho Calabasas606 Las Virgenes608 Palmdale/Acton/Agua Dulce612 Golden Savannahs616 Canyon Star617 Sagebrush624 Woodland Hills636 Kern640 Mission Rose641 Twin Oaks642 Heart of the Valley643 Stoneyridge644 Magnolia647 Lancaster649 Coyote Canyon650 North RiverDo additional adults 18 years of age or older live at this address?* Yes No How many additional adults (18+) live at this address?*12345ADDITIONAL ADULT #1Name* First Last Email* Enter Email Confirm Email Please select all that apply:* Has an active Girl Scout membership Completed an Asurint background screening or live scan fingerprinting Adult is listed on troop roster None apply ADDITIONAL ADULT #2Name* First Last Email* Enter Email Confirm Email Please select all that apply:* Has an active Girl Scout membership Completed an Asurint background screening or live scan fingerprinting Adult is listed on troop roster None apply ADDITIONAL ADULT #3Name* First Last Email* Enter Email Confirm Email Please select all that apply:* Has an active Girl Scout membership Completed an Asurint background screening or live scan fingerprinting Adult is listed on troop roster None apply ADDITIONAL ADULT #4Name* First Last Email* Enter Email Confirm Email Please select all that apply:* Has an active Girl Scout membership Completed an Asurint background screening or live scan fingerprinting Adult is listed on troop roster None apply ADDITIONAL ADULT #5Name* First Last Email* Enter Email Confirm Email Please select all that apply:* Has an active Girl Scout membership Completed an Asurint background screening or live scan fingerprinting Adult is listed on troop roster None apply Confirmation of Compliance Requirements*I understand all adults living in my home, must have a completed background screening, either Asuirnt or live scan fingerprinting and a current Girl Scout membership. GSGLA reserves the right to check and verify the membership and background status of each individual included on this form. I understand the requirements for all adults in order to be in compliance. GSGLA reserves the right to verify any and all compliance statuses. Please check each box to confirm compliance.* The private home must be the home of registered, council approved volunteers. Girl Scout members may not meet in a home where a registered sex offender resides. GSGLA requires membership and background checks for all adults living in the home. Troop members need to be able to focus without disruptions from other household members. Animals should be kept in a place that is separate from the meeting space. Homeowners should consider any personal insurance implications. The homeowner should ask their personal homeowner’s insurance carrier if there are any insurance concerns with troop meetings in the home. Weapons must be out of view and in a locked space. Medication, cleaning products, or any poisonous substances must be stored in a secure space, out of sight, and preferably locked. As long as I continue to meet with my troop, I will fill out this eform on an annual basis. As the submitter of this eForm, I confirm that I have completed Child Abuse and Neglect Prevention training on this date: Training Completion Date* MM slash DD slash YYYY For questions, please contact livescan@girlscoutsla.org.CAPTCHA
