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Boy Scout Troop 19
(Norwalk , Connecticut)
 
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Summer camp medical form


Each Scout and adult staying in camp more than 24 hours must have a completed medical form on file at the Camp HealthLodge. BSA requires a physical evaluation be completed annually for adults and Scouts attending resident camps. A health form signed by a licensed health care provider and dated within one year of the month attending camp must be on file at the camp’s medical facility. The form is good through the last day of the month the physical was done, one year later.
The current BSA Annual Health and Medical Record, a three part (A, B and C) medical history and physical evaluation form, is required for all Scouts and adults attending resident camp. Additionally, Connecticut Yankee Council added an addendum to meet Connecticut DPH regulations. The CYC Addendum is required for all campers under 18 years of age to receive over-the-counter (OTC) drugs and products for the routine treatment of minor ailments and injuries and for issuing preventative topicals such as sun screen.For a camper to carry his/her personal emergency medications (e.g., EPI pen, inhaler, Insulin, etc.) while at camp the State of Connecticut Department of Public Health requires a statement signed by the individual’s medical provider authorizing self administration.

Please print the attached form below as soon as possible so we can get the troop's paperwork in order for a great week at Camp Sequassen.
Attachments
Icon File Name Comment  
ahmr2016fillablerevauth.pdf