Supplemental Health Form 2019

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Boy Scouts of America - Camping and Outdoor Programs

Supplemental Medical Screening Questionnaire for Over The Counter (OTC) medications.

The responses to this questionnaire will accompany the BSA medical form for all campers. You must complete this questionnaire for each *SCOUT* and *ADULT* attending summer camp.

You are entering the data that will populate the following printed form pictured above:
https://drive.google.com/open?id=0B-bWoPYN1wDpS3QtMFROd2loTmc

PART I – TO BE COMPLETED FOR ALL CAMPERS

(This document will be emailed to you for verification. If you notice an error you may resubmit your responses. If you have any questions please email Steven Antolick <steven_antolick@yahoo.com>, Flor Clark <florclark99@hotmail.com>)

Email *

Name *

(Scout's or Adult full name, no nicknames.)

Age *

Unit *

Troop 239G

Troop 291B

Crew 2828

Allergies *

Do you have any medicine, food, or environmental allergies?

Yes

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