Health and Medical Records

All active participants in Scouting activities (scouts, leaders, parents and guardians) must submit a completed BSA Health and Medical Record form annually.  The form can be downloaded from the bottom of this web page.  Please print it out, complete it and submit it to the Troop's Med Form coordinator. 

Part A and Part B of the form is required for participation in any activity of less than 72 hours and can be only needs to be signed by a parent or legal guardian.

Part C is required for participation in any activity lasting 72 hours or more such as summer camp at Hidden Valley or a high adventure trips to Philmont or Seabase. Part C must be signed by a physician, nurse practitioner, or physician assistant. 

PLEASE, Please, please verify your completed form with the checklist below before you submit it to be certain you've completed it correctly.
  1. Make sure a parent or guardian has signed and dated Part A
  2. In Part B: Immunizations, make sure a Tetanus shot date that has occurred within the past 10 years is provided
  3. Make sure a physician has signed and dated Part C
  4. Make sure the date of the physician's signature is legible (this is a common issue - if it isn't legible please clearly write the date next to it and initial)
  5. Make sure you've included a copy of both sides of your health insurance card
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Troop 164 Portsmouth NH,
Oct 11, 2017, 9:24 AM
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Troop 164 Portsmouth NH,
Oct 11, 2017, 9:38 AM
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Troop 164 Portsmouth NH,
Oct 11, 2017, 9:24 AM
Ċ
Troop 164 Portsmouth NH,
Oct 11, 2017, 9:24 AM