Longs Peak Council

Boy Scouts of America

Health and Medical Forms

BSA Annual Health and Medical Form

The Boy Scouts of America recommends that all youth and adult members have annual medical evaluations by a certified and licensed health-care provider. In an effort to provide better care to those who may become ill or injured and to provide youth members and adult leaders a better understanding of their own physical capabilities, the Boy Scouts of America has established minimum standards for providing medical information prior to participating in various activities. Those standards are offered below in one three-part medical form. Note that unit leaders must always protect the privacy of unit participants by protecting their medical information.

Parts A and B

Parts A and B are to be completed at least annually by participants in all Scouting events. This health history, parental/guardian informed consent and hold harmless/release agreement, and talent release statement is to be completed by the participant and parents/guardians.

Part C

Part C is required with parts A and B for any event that exceeds 72 consecutive hours, or when the nature of the activity is strenuous and demanding, such as a high-adventure trek.

For more detailed information, please see the Annual Health and Medical Record page of the BSA's Scouting Safely web site.

Part D

Part D is required to be reviewed by all participants of a high-adventure program at one of the BSA's National High Adventure Bases and shared with the examining health-care provider before completing Part C.

For more detailed information, please see the Annual Health and Medical Record page of the BSA's Scouting Safely web site.

Colorado Certificate of Immunization, Exemptions and Other Authorizations

This form is required by the Colorado Department of Health and the Environment for any event (such as summer camp) in Colorado that exceeds 72 consecutive hours. It is required of both youth and adult participants.

The form has 3 parts on one page:

Approved Alternate Certificate of Immunization - Your Immunization Record
Statement of Exemption to Immunization Law - for Medical, Religious or Personal Reasons
Parent/Guardian Authorizations
- Authorization for other persons to take scout from camp.
- Authorization for off-camp excursions.
- Activity Restrictions
- Permission for child to carry an Epi Pen or Inhaler

En Espanól - Certificado de Inmunización y Padre / Tutor Autorizaciones - also available in Spanish.

Summary of Forms Needed

Nicol Cub Camp Medical Form - Both youth and adults now use:
- The Annual BSA Health and Medical Record, Part A and B
- A medical examination by a physician is not required for Camp Nicol Campers
Boy Scout Camps Medical Forms - Both youth and adults now use:
- The Annual BSA Health and Medical Record, Parts A, B, and C, signed by a physician within the past 12 months.
- PLUS, for Colorado Camps, the Immunization Record and Parent Authorizations
  or Certificado de Inmunización y Padre / Tutor Autorizaciones
- For Backcountry / High Adventure participants, the Annual BSA Health and Medical Record, Part D is required to be reviewed by all participants and shared with the examining health-care provider before completing Part C.
Day Camps, Weekend Events and Other Short-Term Events (less than 72 hours) - Both youth and adults now use:
- The Annual BSA Health and Medical Record, Part A and B
- A medical examination by a physician is not required.

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Last Updated Sunday, 18-Mar-2012 17:45:32 MDT