Required Forms 2021
2021 Medical Form Information
Medical forms are found on the bottom of this page. Please use only the medical forms found on this site.
Part A: Informed Consent, Release Agreement, and Authorization
- This form is the permission for the camper to participate in camp activities as well as stipulates who may or may not remove the camper from camp.
Part B1: General Information/Health History (Page 1)
PLEASE NOTE: This information must be completed even if you are using a state (school) physical form.
- Telephone Number: Camper’s home phone number; mobile phone is a parent’s mobile number.
- Unit Leader: N/A
- Council: N/A
- Unit: N/A
- Your health insurance company and member ID are critical if the camper or staffer must go to the urgent care center or emergency room. (Please attach a copy of your health insurance card, both front and back.)
- Health History: By using the fillable form, you can just click on each item and type in any explanations as needed.
Part B2: General Information/Health History (Page 2)
- Allergies: Does the camper have allergic reactions to food, medications, plants, and/or insects that could require medical treatment? If the answer is yes to any of the allergens, an Authorization to Administer Medication form from the examining Physician/PA/APRN must be attached to the physical form.
- Immunization history with dates or a copy of immunization history from doctor’s office. If using a copy of the immunization history, it must be a legible copy signed and dated by the physician. Your health care provider may write “Up-To-Date” and sign in the box.
- Tetanus must be within 10 years. Please enter this date regardless if using an immunization history.
- Medications: This form is used by the BSA nationally, but Connecticut has special requirements for the administration of medications in camps, schools, etc. In Part D, there is a listing of medications that can be administered at camp without a physician’s order. It is very limited. For all other medications, both prescribed and over the counter, an Authorization for Administration of Medication form must be completed, signed, and dated by the physician and parent. A separate form is required for each medication. NOTE: All medications must be physically checked by the nurse at check-in and be in there originally packaging with Rx label.
Part C: Physical Examination
- Signed and dated by doctor within ONE (1) year of first day of camp.
- You may substitute a doctor’s form or school form for Part C.
Part D: Camp Seton Addendum
- Completed, signed and dated by parent or guardian. This is required by the State of Connecticut.
- CT State requires that medications be stored in their original packaging with Rx label
- All medications will be given at the camp office.
Campers with Special Needs
If a Camper has a Care Plan (504, IEP) for school it is recommended that accomodations be discussed with the Camp Director. The information is kept confidential on a need to know basis.
- All four parts of the BSA form must be completed and submitted along with any applicable Authorization for Administration of Medication and Individual Plan of Care.
- Make copies of all medical forms prior to submission. All medical forms should be submitted to camp at least three weeks prior to your arrival at camp.
- Do not fax or email forms to camp.
- Mail forms to:
c/o Greenwich Council, BSA
63 Mason St.
Greenwich, CT. 06830
- Please drop off to the Council Office:
63 Mason Street, Greenwich, CT.
Our health officers will review all forms and inform you of any problems to address prior to your arrival at camp. All completed Health Forms MUST be submitted 3 weeks prior to attending Camp! Please understand that submitting all forms three weeks ahead of camp will help streamline your check-in process.
Email all medical related questions to firstname.lastname@example.org
NOTE: PHYSICAL EXAM MUST BE WITHIN 1 YEAR OF FIRST DAY OF CAMP
|Authorization for Administration of Medication (IF APPLICABLE)||This form must be completed, signed and dated by the physician and parent for campers requiring the adminstration of medication during camp hours. A separate form is required for each medication. NOTE: All medications must be physically checked by the nurse at check-in and be in there originally packaging with Rx label. ***Please note: School and other camp forms are not accepted in place of our camp form. This form authorizes Camp Seton's personnel to administer medication only.***||Download|
|Individual Plan of Care (IF APPLICABLE)||An Individual Plan of Care is necessary when a child has a special health care need or disability and it is necessary that special care be taken or provided while the child is at the youth camp.||Download|
|Part D: Camp Seton Addendum (REQUIRED)||Completed, signed and dated by parent or guardian. This is required by the State of Connecticut.||Download|