Existing Scouts and Adults

The BSA Annual Health and Medical Record needs to be completed and submitted ANNUALLY.  This form is for both youth and adult members and is usually submitted in the spring of each year.  Use the 4-page version with Parts A, B & C.  Click here to download.
See below for instructions and risk advisories for high-adventure camps.
 

New Scouts and Adults Joining Troop 55

For a BOY to become a Scout in Troop 55, his parents need to submit the following forms: (see below for links)
•  BSA Annual Health and Medical Record
        (Parts A & B before first campout, Parts A, B & C before summer camp)
•  Consent and Release / Hold Harmless Agreement
•  Consent to Medical Care and Treatment of a Minor
•  Over-the-Counter Medication Authorization / Dietary Restrictions Form
•  Photocopy of Health Insurance Card (front and back)
•  Immunization Record (Tetanus required and valid within the last 10 years)

For an ADULT to become involved in Troop 55, he or she needs to submit the following forms:
•  BSA Annual Health and Medical Record (Parts A, B & C)
•  Photocopy of Health Insurance Card (front and back)
•  Immunization Record (Tetanus required and valid within the last 10 years)

Instruction on where to send the forms is at the bottom of this webpage.

Medical Forms Overview and Guidance

Annual Health and Medical Record

Instructions  (click to download, PDF, 1 page)

Parts A & B  (PDF, 3 pages).

Parts A, B & C  (PDF, 4 pages)

Parts A and B are needed for registration and participation in all Troop 55 activities. Parts A and B can be completed by the parent or guardian and do not require a doctor's exam or signature.

Part A is Informed Consent, Release Agreement, and Authorization.

Part B is General Information/Health History.  Attach a copy of your medical insurance card, front and back, or write "None" on the form if you have no medical insurance.  For the immunization section, you can write "see attached" and attach a separate sheet with the information or a copy of doctor's immunization report.

Part C of this form is completed by a physician.  Part C is needed prior to summer camp, any high-adventure activity, or various other activities as described on the form.  Part C is also needed for a Scout to attend NYLT or NAYLE, or for an adult to attend Wood Badge.

Suggestion:  If a participant's BSA activity will occur within 12 months of his last physical exam, please drop Part C off at the doctor's office now and have it completed based on the information from the last exam.  If participant's physical exam has yet to occur but will take place before May 15, print Part C and take it with you to your doctor's visit.  If participant's annual physical usually occurs in the summer months, please take time now to consider your options for completing your Part C in advance of the May 15 medical forms deadline.  Contact T-55's Medical Records Coordinator to make special arrangements.

Consent and Release / Hold Harmless Agreement

Click here to download form (PDF, 1 page).  To be completed only once on behalf of each youth participant at Troop 55.

Consent to Medical Care and Treatment of a Minor

Click here to download form (PDF, 1 page).  Requires notary seal/signature.  To be completed only once on behalf of each youth participant at Troop 55.  This document is required by some hospitals prior to treatment of a minor when neither of his parents are present.

Over-the-Counter Medication Authorization / Dietary Restrictions Form

Click here to download form (PDF, 1 page).  This form should be submitted if a scout is to receive over-the-counter medications during campouts or at summer camp, or if the scout has dietary restrictions.  The form should be revised and resubmitted if the participant's medical/dietary information changes.

BSA High-Adventure Participants

There is a separate risk advisory for several of BSA's high-adventure camps, and this needs to be reviewed by participants in those camps.  The risk advisory document is for review only and does not need to be printed or submitted to T-55 along with Parts A, B and C of the medical form.

Click to download the appropriate risk advisory (along with the medical form):
•  Risk Advisory for Philmont  (PDF, 6 pages)
•  Risk Advisory for Florida Sea Base  (PDF, 6 pages)
•  Risk Advisory for Northern Tier Canoe Base  (PDF, 6 pages)
•  Risk Advisory for Summit Bechtel Reserve  (PDF, 6 pages)
•  Medical Form for Scuba  (PDF, 6 pages)

Where to send completed forms

You should save copies of these forms for your perrsonal records and submit your completed original forms to:
Mrs. Julia Humphreys, T-55's Medical Records Coordinator,
Mail/hand-delivery:  3708 Chevy Chase Drive, Houston, TX 77019
Scan/email (no photos, please):  medical@troop55.org and jchumphreys@sbcglobal.net
Questions:  713-320-8184