Bsa medical form 5 free templates in pdf, word, excel download. Below is a list of forms that are specific to the boy scouts of america, laurel highlands council. Those standards are offered below in one threepart medical form. Annual health and medical record boy scouts of america. Because the form provides legal consent for treatment it also removes the boy scouts of america from being held liable for or responsible potential issues. Boy scouts of america all class 3 activities require a health examination within the past 12 months by a licensed healthcare practitioner. Visit a physicians office, preferably one who delivers primary care. Summer camp medical form new birth of freedom council, bsa. Claimants address street, city, state, zip code and best contact telephone number include area code. The form further provides the responsible party to make health or medical treatment decisions in relation to the child listed on the form. The council will scan all medical forms into pdf format. Sign, fax and printable from pc, ipad, tablet or mobile. Some scouts arrive at a highadventure base without discussing that bases risk factors with their health care provider, meaning they have missing info at checkin that can slow down the process. Please support the bsa today to help ensure a bright, strong future for americas youth.
And while its too early to pack your bags and load the trailer, the time is right for one essential step in summer scouting preparation. Summer camp medical form were mere months away from the summer, aka the greatest scouting season. Required for bsa aviation flights and recommended for all activities. Broad creek memorial scout reservation 1929 susquehanna hall road whiteford, md 21160. Medical forms just had a look on scout base but dont seem to be able to find a medical form for parents to fill out please could somebody help. Including the dan beard district and the two mountains district.
Gift aid information for the hmrc is not collected using this information form. Providing your medical information on this fourpart form will help ensure. Get, create, make and sign boy scout of america physical form. A boy scouts of america parental consent form is a form that parents or legal guardians of children must sign in order to allow children to participate in activities hosted by the boy scouts of america. In the summer, scouts from northern tiers three wilderness canoe bases explore millions of acres of pristine lakes, meandering rivers, dense forests and wetlands in northern minnesota, northwest ontario and northeast manitoba. Formerly called the bsa medical exam form class 1, 2 and 3. Fill bsa medical form 2020 danbeard instantly, edit online. Medical providers are authorized to disclose protected health information to the adult in charge, camp medical staff, camp management, andor any physician or healthcare provider involved in. Because many states regulate the camping industry, this annual health and medical record also serves as a tool that enables councils to operate day and resident camps and adhere to state and bsa requirements.
Howeve, so that leaders can be as familiar as possible with any limitations, list any restrictions imposed on a child participant in connection with programs or activities below. Please list all medications taken in the 30 days prior to arrival at the scouting activity where this form is to be used. In order to provide better care for its members and to assist them in better understanding their own physical capabilities, the boy scouts of america recommends that everyone who participates in a scouting event have an annual medical evaluation by a certified and licensed healthcare providera physician md or do, nurse practitioner, or physician assistant. Over 31 million copies of the official handbook for boys have been distributed since this first edition was published in 1911. A medical examination is completed for trips lasting more than three nights. How to handle prescription medication on scout trips. A scout group planning an adventurous camp or activity with its scouts makes use of this health certificate form to record the results of the medical examination conducted on the participants which help them ensure that the scouts are medically fit. The following links contain the pdf fillable forms and information for their use. This is the one the adult or the scouts parents fill out. Quicky look up the latest merit badge requirements for all. We still recommend that scouts and volunteers keep a master copy of their annual health and medical record and submit a copy of this master for each activity. Medical consent form 5 documents dot physical form 2 documents bsa medical form 3 documents medical application form 4 documents generic authorization medical release form 8 documents immunization record 5 documents medical records request form 8 documents health and safety policy statement 3 documents hc1 form 2 documents. Form, make a copy for your records and submit the entire medical form in original, with a copy of both sides of your insurance card, to your jamboree troop committee chair or hisher designee.
I also hereby assign and grant to the local council and the boy scouts of america, as well as their. Girl scouts of america health history and medical examination form for minors health history. I release the boy scouts of america, the local council, the activity coordinators. Part c parental informed consent and hold harmlessrelease. Print page 8 of part d and bring it to your doctor to perform a physical exam and complete and sign part c of the printed medical form part d has the bechtel summit high adventure requirements. Applies to all participantsin basic scouting activities such as local tours and weekend camping trips less than 72 hours in duration. Bsa health forms, now as easy as a, b, c bryan on scouting. With our impressive collection of scout health forms, designing a form. Benefits information above is provided anonymously by current and former boy scouts of america employees, and may include a summary provided by the employer. Scoutbook 2020 scouts bsa merit badge requirements.
Scouting magazine is published five times a year and. Learn about boy scouts of america health insurance, including a description from the employer, and comments and ratings provided anonymously by current and former boy scouts of america employees. I release the boy scouts of america, the local council, the activity coordinators, and all employees, volunteers, related parties, or other. Northern tier is the boy scouts of americas gateway to adventure in the great northwoods. Read this page for additional jamboreespecific instructions. During these challenging times, the boy scouts of america needs you more than ever. Claimants address street, city, state, zip code and best contact telephone number include area code 6. Using a scout health form ensures that the health details are recorded and filed in an organized manner and can be easily accessed at a later date. Discuss the components of a medical history and physical examination an official bsa health form may be.
Annual health and medical record the scouting adventure, camping trips, highadventure excursions, and having fun are important to everyone in scoutingand so is your safety and wellbeing. Completing the annual health and medical record is the first step in making sure you have a great scouting experience. Medical form parts a, b and c required for summer camp medical forms faq bsa medical form instructions t medication policy and forms. Boy scout physical assessment forms are there to make sure that each and every one of them is in tiptop shape to carry out specific duties. This helps certain boy scout organizations know which of their scouts can perform certain services and which of them should stick to other duties that will not do anything to harm their health. Parts a and b are required for all scouts and adults participating in any scouting events. Bsa medical form 5 free templates in pdf, word, excel. Free boy scouts of america bsa parental consent form pdf. In an effort to provide better care to those who may become. Free boy scouts of america bsa parental consent form. Its use will be mandatory for the 2010 national scout jamboree. Completing the annual health and medical record is the first step in making sure you have a. Day camp health form northeastern pennsylvania council.
Download free printable bsa medical form samples in pdf, word and excel formats. Annual health and medical record valid for 12 calendar months medical information. Contact 2 if required parentguardian information title surname. Theyre a welltrained and welldisciplined group of young men who see to the needs of others and do so in a properly and orderly fashion.
The original boy scout handbook standardized american scouting and emphasized the virtues and qualifications for scoutingdelineating what the american boy scouts declared was needed to be a welldeveloped, wellinformed boy. Medical records may not be collected until the conclusion of the event or until the individual completes the event checkout process. Search and rescue sar merit badge, kayaking merit badge, welding merit badge. Allegheny county parks foundation eagle scout project award program. Learn about boy scouts of america, including insurance benefits, retirement benefits, and vacation policy. It should be recorded in a suitable format, such as the form that can be found in the members area of. The official handbook for boys boy scouts of america. Forms baltimore area council, boy scouts of america. Scouting activities, and i hereby release the boy scouts of america, the local.
Part 1 leaders statement boy scouts of america national. Bryan on scouting is the official blog of scouting magazine, a boy scouts of america publication. Girl scouts health history and medical examination form. Crossroads of america council, boy scouts of america part a. Glassdoor is your resource for information about the health insurance benefits at boy scouts of america. Boy scouts of america hudson valley council annual health. The more complete information you provide, the better we are able to work with your child to ensure she receives the care she needs.
Whether you would like to schedule a visit or have questions about troop, our team is here for you. The boy scouts of america requires an annual physical by a healthcare professional in order to participate in scouting activities, long term camps, jamboree, and high adventure bases. To be filled out by parent, guardian, or adult participant. Lifesaving or meritorious action award application. Note that unit leaders must always protect the privacy of unit participants by protecting their medical information. This includes youth and adult members participating in highadventure activities, athletic competition, and world jamborees. The boy scouts of america recommends that all youth and adult members have annual medical evaluations by a certified and licensed healthcare provider. The tall pines council risk management committee has provided a form that may be of benefit for your next event. Because the form provides legal consent for treatment. Northeast pennsylvania council, boy scouts of america. Date of birth the padi medical form is also required if scuba diving at this base.