SUMMER CAMP MEDICAL FORMS
The Annual Health and Medical Record
This is a fillable PDF. It is required for all Scouts, Leaders, Tot-Lot-Participants, Girl Scouts. & volunteers. Please read all instructions carefully

Permission To Adminster Medication At Camp.

Medication Authorization is required for all Camping Programs held in Massachusetts. (West Wind & Moonraker Day Camps Only)
What form do you need for what Yankee Clipper Council Camp Program?
All participants attending any of our camp programs must bring a copy of both sides of their Medical Insurance Cards. This includes leaders, parents, guests and young children. If you don't have insurance enter none at the appropriate space on the BSA Medical Form.
Camping  Program Documents Required
BOY SCOUT CAMP
Wah-Tut-Ca Scout Reservation BSA Annual Health and Medical Record (2012 Printing, Rev. 9/2012) Parts A, B, & C
Wah-Tut-Ca Extreme Programs BSA Annual Health and Medical Record (2012 Printing, Rev. 9/2012) Parts A, B, & C
Boy Scout EAGLE Week (Lone Tree Scout Reservation) BSA Annual Health and Medical Record (2012 Printing, Rev. 9/2012) Parts A, B, & C
CAMPS FOR CUB & WEBELOS SCOUTS
Lone Tree Cub Scout Resident Camp BSA Annual Health and Medical Record (2012 Printing, Rev. 9/2012) Parts A, B, & C
Camp So-Key-Tay (Webelos Resident) BSA Annual Health and Medical Record (2012 Printing, Rev. 9/2012) Parts A, B, & C
Lone Tree Day Camp BSA Annual Health and Medical Record (2012 Printing, Rev. 9/2012) Parts A, B, & C
Discovery Cub Scout Science Camp BSA Annual Health and Medical Record (2012 Printing, Rev. 9/2012) Parts A, B, & C
C.O.W (Cub Overnight Weekend) BSA Annual Health and Medical Record (2012 Printing, Rev. 9/2012) Parts A & B
Family Camp BSA Annual Health and Medical Record (2012 Printing, Rev. 9/2012) Parts A & B
West Wind Day Camp, Chelmsford MA* BSA Annual Health and Medical Record (2012 Printing, Rev. 9/2012) Parts A, B, & C
Authorization To Administer Medication To A Camper
Updated Immunization Record (Provided by Physician) including date (MM/YY) of last tetanus shot)
MoonRaker, Topsfield MA* BSA Annual Health and Medical Record (2012 Printing, Rev. 9/2012) Parts A, B, & C
Authorization To Administer Medication To A Camper
Updated Immunization Record (Provided by Physician) including date (MM/YY) of last tetanus shot)
* All Camps held in Massachusetts requires Authorization To Administer Medication To Camper inaccordance with 105 CMR 430.160.
* All Camps held in Massachusetts requires an updated Immunization Record, provided by Physician including last tetanus shot date (MM/YY)

 

Serving Children and Young Adults in 52 communities in Northeastern Massachusetts and Southern New Hampshire.
Yankee Clipper Council, BSA ● 36 Amesbury Rd. ● Haverhill, MA 01830-2802
Tel: 978.372.0591 ● Fax: 978.373.9134 OFFICE HOURS 8 am to 5 pm Monday through Friday