2022 LEADER'S GUIDE CAMP HUNT SCOUTS BSA

 
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2022 LEADER'S GUIDE CAMP HUNT SCOUTS BSA
CAMP HUNT
SCOUTS BSA   2022
    LEADER’S GUIDE
2022 LEADER'S GUIDE CAMP HUNT SCOUTS BSA
2022 Leader’s Guide

                   CAMP HUNT
              CONTACT INFORMATION

                 Website: utahscouts.org/hunt

        CAMP RESERVATIONS AND INFORMATION
          TERRI COMBER & ROBIN SIMMONS
                Administrative Assistants
              program.office@scouting.org
                    (801) 479-5460

          CAMP FEE PAYMENT INFORMATION
     For mailing payments use the following address:
              Crossroads of the West Council
                      1200 E 5400 S
                    Ogden, Utah 84403
                For online payments visit:
                     utahscouts.org

                   HUNT CAMP DIRECTOR
                      BRIAN SIMMONS
                   bdscamphunt@gmail.com

          CROSSROADS OF THE WEST COUNCIL
                 CAMPING DIRECTOR
                     JEREMY BELL
                jeremy.bell@scouting.org
                     (801) 645-8916

                  CAMP HUNT
      EMERGENCY PHONE DURING CAMP SEASON
                 (801) 475-7485

Camp Hunt does not discriminate against anyone on the basis
 of race, color, national origin, religion, age, sex, handicap, or
                any other delineation of peoples.
2022 LEADER'S GUIDE CAMP HUNT SCOUTS BSA
HUNT
                   CAMP OVERVIEW
Tucked neatly amid a grove of cottonwood, river birch, maple, and pine
  trees on the shores of Bear Lake, Camp Hunt is all about aquatics!

Camp Hunt is located on the west shore of Bear Lake 2 miles north of
  Garden City, Utah. The camp features renovated/new facilities
               including: docks, and shower facilities.

      Hunt is nationally accredited by the Boy Scouts of America.

               2               250                109
       Weeks to choose        Total camp         Square miles
       from during 2022.     capacity each         of water!
                               session.
          2   Miles north of Garden City, Utah

         26   Campsites located along the shore of Bear Lake

              Typical summer daytime high temperatures with
High 80’s     nighttime lows in the 50’s.

HUNT IS…
ADVENTURE: We delight in the thrill of discovery and helping others discover their own adventures.
ENTHUSIASTIC: We love Hunt and we joyfully do our best to make each session the most exciting camp
experience ever.
DIVERSE: We value all people and celebrate the differences that make us all special.
FRIENDLY: We reflect the values of the Scout Oath and Law in all that we do.
SERVICE DRIVEN: We are happy to be here and honored to serve you.
2022 LEADER'S GUIDE CAMP HUNT SCOUTS BSA
PLANNING FOR CAMP
We are very happy you have chosen Camp Hunt for your upcoming Scout camp! We promise to do
all in our power to make your Scout camp memorable and successful. We have found the best Scout
camps are those planned together by youth and leaders. One way to structure your leadership is
outlined below.

Scoutmaster
As the adult in charge of your event, it is your responsibility to oversee the entire organization and
development of the event and to see the goals of the event are met. We encourage you to keep a low
profile. Let the youth plan their own agenda as much as possible. There will be times when your
expertise and experience will be needed, so don't hesitate to offer suggestions and ideas to smooth
out the rough spots. Youth want to show that they are capable and will do an excellent job when
given the opportunity.

Senior Patrol Leader & Patrol Leaders
As youth leaders, you have one of the most important jobs. Scout camp may have more influence on
your peers than any other activity held during the year. You are responsible for overseeing the
planning and conducting of the events while at Camp Hunt. Remember to keep the goals for the
events in mind when planning. Be prepared for committee meetings and set specific tasks to reach
your goals.
       Prior to camp
          • Work with adult leaders
          • Develop goals and themes
          • Coordinate all committees
          • Follow deadlines
       During the camp
          • Work with Camp Hunt Staff
          • Conduct all meetings
                 • Orientation & general meetings
                 • Special meetings (firesides, testimonies, etc.)
          • Encourage peers to follow camp rules
          • Keep records of advancement & participation (Fellowship of the Lake, etc)
Adult Supervisors:
We strongly urge you to plan sufficient adult supervision for the size of your Scout camp group.

Schedules:
Please consult the week at a glance schedule. Camp Hunt offers activities throughout the day, including
evening programs, merit badge activities and advancement programs.
2022 LEADER'S GUIDE CAMP HUNT SCOUTS BSA
PLANNING FOR CAMP
Pre-Camp Checklist
   16 weeks before camp - Parent’s night conducted to inform parents of camp
   plans
   Early Spring - Watch the Camp Hunt pre-camp video on YouTube
   12 weeks - Leadership arranged, two-deep leadership at all times
   May 1- Half of your group’s camp fees are due to Crossroads of the West
   Council
   May 2 - Online merit badge registration opens
   8 weeks - Remind parents that all camp attendees need health forms
   8 weeks - Participants have personal equipment list
   4 weeks - Health & medical record completed for each youth & adult (Parts A, B,
   and C)
   4 weeks - All youth and adults are registered with your Troop
   4 weeks - Transportation arranged and insurance verified
   4 weeks - Group camping equipment ready
   1 week - Final camp fee due
   1 week - Print group roster and bring with you to camp
2022 LEADER'S GUIDE CAMP HUNT SCOUTS BSA
PROGRAM OPPORTUNITIES
                            Along with the great location and staff at Camp Hunt, camp programs are the
                            best anywhere! Scouts and leaders will be challenged to fit merit badge
                            courses, free- time elective activities, and special programs into a busy week of
                            camp. Pre- planning is essential. Check out our great programs.

                            Flag Ceremonies
                            These include fun, games, and a chance to show off your Troop spirit.
                            Information concerning the day’s activities will be presented and scouts will be
                            able to experience patriotic ceremonies and build their appreciation for our
                            great country.

    Swim Check
                            Troop Service Projects
It is recommended that
groups do this at a         If desired, we provide opportunities for your Unit to do service projects while in
community pool before       camp. Many Troops feel this is an important part of their summer camp
arriving at camp. This      experience. Projects can range from very simple to more complex. Often adults
helps speed up the          with special talents can do more intricate and exacting work. The camp will
check-in process at camp
- as it much warmer than
                            tailor projects to your Troops’ age and skill. We are always looking for people
the water at camp!          who would like to help Camp Hunt become even better. Anyone interested in
                            joining our support team, please notify the Camp Director. All aspects of
                            support can be used and are greatly appreciated.

                            Leader’s Training
                            Throughout the week, our staff will provide Round Tables which are open to all
                            adult leaders, and the camp will also offer; Youth Protection certification, Safe
                            Swim Defense and Safety Afloat cards.

   Buddy System             Campsite Inspections
All campers should have     Campsites will be inspected each day by the commissioner and Senior Patrol
a buddy while at camp.      Leaders within each Commissioner area. The purpose is to improve health and
Your buddy has your         safety, patrol method, and scout spirit.
back and you have your
buddies back! Watch out
for, and help each other.   Campfires
                            There will be campfire programs for the entire camp on Monday and Friday
                            nights performed at Hunt’ s fabulous fire bowl overlooking Bear Lake. On
                            Wednesday nights, Commissioners will direct campfires where each troop will
                            perform for the troops assigned to each commissioner area. Check with your
                            Camp Friend for ideas for skits and songs to be ready to show the camp. The
                            Commissioner will need to review and approve all skits and songs.
2022 LEADER'S GUIDE CAMP HUNT SCOUTS BSA
PROGRAM OPPORTUNITIES
Swimming
Camp Hunt has a great swimming area, operated in strict accordance with BSA
policies and is used for general swims during free time, merit badge classes,
and rank advancement instruction. Don’t forget the mile swim. A mile in Bear
Lake will give you bragging rights for life!!!

Boating
Camp Hunt provides canoes, stand up paddle boards and kayaks. These are
available for use during all free time sessions. Camp also offers a sailing
opportunity for those involved in the ACE program. Come on down and enjoy!!
This is a great opportunity for Scouts and leaders to practice their boating skills
or just have fun. Certified swimmers may use sail boats, stand-ups, canoes and
kayaks. Everyone must use a PFD. An orientation and demonstration of ability
is required to use equipment. Please remember that all persons on the water
are responsible for their actions and care must be taken to ensure safety.

Polar Bear Society
This is a chance for Scouts to learn about nature by experiencing it!
Membership in the Camp Hunt Polar Bear Society is open to all campers.

Washakie Games
All Troops are invited to participate in games and skill activities conducted by
the staff on Tuesday evening. This is a chance to have a positive interaction
with all the other campers at Hunt and an opportunity to build team and scout
spirit.

Nature Area And Trail
Camp Hunt offers many opportunities to discover and learn about our
environment. We offer a nature trail which is set up to be staff-led or self-
guided.

Archery Range
An archery range is available, and all participants receive safety orientation and
skill training. Arrows are provided.

Sunrise Canoe Trip
Wake up early to watch the sun rise over Bear Lake while sitting in our 20-
person warrior canoes.
2022 LEADER'S GUIDE CAMP HUNT SCOUTS BSA
PROGRAM OPPORTUNITIES
Mile Swim
This is an individual activity. Participants will need another Troop member to
supervise and count laps, and will need to work with the Waterfront Director for
times, locations, and equipment to be utilized.

Waterfront Olympics
This event starts with the Bear Lake Monster relay and includes countless
games and activities on the beach.

Order of the Arrow
The Order of the Arrow (OA) is Scouting’s National Honor Society. A major
component of the OA is camping and camp promotion. The Council’s OA
Lodge, the Ammatdiio (Ah-mah-Di-yo) Lodge will have representatives available
at camp to perform unit elections, or answer any questions you may have. If
you are a member of the OA, bring your sash and wear it on OA day!
2022 LEADER'S GUIDE CAMP HUNT SCOUTS BSA
RANK ADVANCEMENT
The primary responsibility for rank advancement is that of the unit leaders and
the unit committee. Camp Hunt assists Unit leadership by providing the finest
in instruction and counseling. Although staff instructors and counselors will
provide accurate records for information covered and skill accomplished, it is
the responsibility of each unit leader to mark rank advancements in each
youth’s individual record (usually in their handbook). Camp counselors will also
sign merit badge cards, but the Unit is responsible to ensure they are properly
recorded in each youth’s permanent record.

Advancement Policies
All advancement will be in accordance with BSA National Standards. Merit
badge counselors and instruction will be supervised by trained Directors, 18
years of age or older. Blue cards for completed merit badges will be provided
by Camp Hunt. Those not completing all requirements for a specific merit
badge will be given partial completion slips. Boards of Review may be
conducted in camp if adequate adult leadership is available. Appropriate adult
representation on the board, however, is the responsibility of each Unit. The
Scoutmaster, Advisors or Skipper is responsible to prepare, monitor, and verify
completion of the Scout’s advancement. Preparing for each merit badge by the
Scout is highly encouraged and work done before camp is acceptable. Any
Scout receiving a merit badge from Camp Hunt will know the subject matter
and have learned the practical skills associated with the merit badge.

NOTE: Unit leaders are given an opportunity to review all advancement records
before leaving camp and are encouraged to review them at home and give the
records and cards to the Unit Advancement Chairman.

Trail to First Class Program
The Trail to First Class program at Camp Hunt is designed to provide new and
young Scouts a program where they can learn basic Scout skills. Many of the
skills taught will complete requirements for Tenderfoot to First Class ranks;
however, we recommend that all campers participate in these activities.
Activities in this program are offered during the third merit badge time slot, or
are available to all Scouts during Tuesday, Thursday, and Friday free time
periods. Specific requirements are posted towards the end of this guide.

Merit Badge Program
The following is a list of merit badges offered at Camp Hunt. Any registered
merit badge counselor who would like to offer or teach additional badges while
at camp is welcome. Please contact the Program Director. For all badges listed
below, the camp provides staff counselors and instructors.
2022 LEADER'S GUIDE CAMP HUNT SCOUTS BSA
RANK ADVANCEMENT
Class Time Offerings
• Trail to First class - Class hour #1, 2, 3
• Archery - Class hours #1, 2, 3
• Astronomy - Class hours #2, 3
• Orienteering - Class hours #2
• Personal fitness - Class hours #3
• Sports - Class hour #1
• Canoeing - Class hours #1, 2, 3
• Kayaking - Class hours #1, 2, 3
• Lifesaving - Class hours #3
• Small boat sailing - Class hours #1, 2, 3
• Swimming - Class hours #1, 2
• Emergency preparedness - Class hours #2, 3
• Environmental science - Class hours #1, 2, 3
• First aid - Class hours #1, 2, 3
• Fish & wildlife - Class #1, 3
• Forestry - Class #1, 3
• Indian lore - Class #1, 3 ($)
• Leatherwork - Class #2, 3 ($)
• Mammal study & Nature - Class #1, 2
• Pioneering - Class #1, 2
• Search and rescue - Class #2, 3
• Wilderness survival - Class hours #1, 3
• Wood Carving - Class #1, 2

DURING “FREE TIME” the Waterfront and Archery merit badges are not offered
but all others are available with the addition of:
• Basketry ($)
• Chess

Camping, cooking, and hiking merit badges are signed off by the Scout’s own
Unit Leaders.

Merit Badge Preparation
Some Merit Badges have requirements that cannot be completed in a week of
summer camp. If your Scouts are interested in finishing any of these at camp,
ensure the following requirements are completed prior to arriving at camp.
   • Emergency Preparedness - requirements #2c and #8b
   • Life Saving - CPR training, 2nd Class 5A-5D, 1st Class 6a. Know front crawl,
     sidestroke breaststroke and elementary backstroke
   • Nature - requirement #4
   • Personal Fitness - requirements #8 and #9
   • Sports - requirements #4 and #5
CAMP LIFE
Special Needs Requests
All special medical conditions should be reported to the health officer upon
arrival in camp. If there is a camper with special needs, please contact the
camp director so we can make the appropriate accommodations.

Campsite Accommodations
Each campsite has a picnic table (or more) and campfire pit. Participants and
groups need to plan on bringing their own tents. We encourage groups to
bring wagons or wheel barrows to get your equipment from the parking lot to
your campsite.

Restrooms
Camp Hunt provides three bathroom facilities with all flushing toilets to
campers. Please do not throw any garbage down the toilets. This includes:
feminine hygiene of any kind, pads, inserts, applicators, wrappers, hand wipes
or baby wipes, toilet paper rolls, wrappers, candy wrappers, or food items.

Camp Hunt operates a sewer pump to take waste up to the city sewer system.
These items clog the pump and prevent the removal of waste from working
properly. There are garbage cans in every stall, please use them. When the
garbage cans get full, please empty and replace the can liners. There are extra
garbage bags and toilet paper in the restroom’s janitorial closet. There are also
bathrooms and showers in the main lodge for adults in camp.

Water
Each campsite has a nearby water spigot with potable water. Encourage your
participants to stay hydrated!

Ecology
Please make certain that all group members understand the delicate balance of
plant and animal life in the wilderness. Everyone should do their best to ensure
that no animals are molested or killed - this applies to aquatic as well as land
life.

No pets of any kind should be brought to camp. Pets are a threat to wildlife
and are in danger themselves.

Never cut down a tree, dead or alive. Do not carve names or symbols into the
trees or do anything else that could damage the trees.

Tree Climbing
Camp Hunt has a strict no tree climbing policy. Participants (youth or adult)
that are discovered to be climbing trees will be sent home.
CAMP LIFE
                             Hammocks
                             Those that wish to use hammocks at camp must provide their own free-
                             standing frame. Adults are encouraged to ensure a hammock’s set-up is safe
                             for the individual using the hammock.

                             Fire
                             The smallest spark is a deadly threat to wildlife and campers. No fireworks are
   PETS ARE NOT
                             allowed in camp. All fires must be confined to the designated fire pits in each
     ALLOWED                 campsite. Restrictions are posted online at www.utahscouts.org/safety.
No pets are allowed in
camp at any time except      Firewood
service animals.
                             There is some wood scraps on our property that you may use for your fires.
                             We encourage groups to bring a small load of firewood you wish to have
                             campfires.

                             Quiet Hours
                             We are required to provide all campers with at least nine hours of quiet time.
                             Between 10:00 PM and 7:00 AM each day we ask that you enforce this quiet
                             period.

                             Showers
                             Camp Hunt’s North and South showers are available for all youth and adults to
   TRADING POST              use as they are individual rooms with locks. The Central Showers are limited to
                             youth only.
The Trading Post is
stocked with merit badge
                             Depending on the groups in camp each week, will depend on which bathrooms
kits, snack items, drinks,
ice cream, candy, t-shirts   are designated for boys and which are designated for girls. This will be clearly
and other items.             marked and your group will be informed at check-in which bathrooms will be
                             designated male and female.

                             Vehicles, Trailers, and Parking
                             Vehicles parked on camp property must display a camp vehicle registration
                             card that will allow camp staff to contact the owner/operator in the event of an
                             emergency or other need. These registration cards are attached to this packet.

                             Please do not allow anyone in the back of trucks or in trailers while transporting
                             equipment. Trucks, cars, vans, trailers and RVs must park in the designated
                             parking lots. While driving in camp, please stay below 15 MPH.
FOOD SERVICE
It is our hope to serve you well while you’re at Camp Hunt. Our Staff is here to
be of assistance to you.

Dining Hall
This service includes three balanced meals prepared by our cooks, each day.
Reservations for guests must be made and paid for in advance: $7 per meal.
Participants must be washed and wearing full uniform is encouraged for
evening meals. Units will be on a rotation for after-meal cleanup.

Bring Your Own Food
Simple: you bring it, you prepare it, and you store it. Food storage will be your
responsibility. Ice is available for purchase in the commissary for $2 per bag.

When washing dishes, use hot water. It is recommended that to wash and
rinse in an approved disinfectant after all meals. Allow each dish to air dry.
After drying, store in a clean place. This will prevent diarrhea and other contact
diseases.

Food storage will be your responsibility.

Allergy Accommodations
If you have an allergy to items posted on our menu, please notify our camp
staff 2 weeks prior to arriving at camp by filling out our allergy form online at
www.utahscouts.org/allergy. If our staff have concerns about accommodating
your particular allergy, we will reach out to you.

Menus
Menus will be posted online by early Spring.
HEALTH & SAFETY
Emergency Procedures
In any large-scale operation, there exists the possibility of “emergencies.” This procedure is to help the
staff and leaders perform efficiently in any emergency and keep everyone informed.

Weather-Related Emergencies
Camp Management makes every reasonable effort to monitor weather conditions that may pose a
threat to the health and safety of the camp. Leaders are ultimately responsible for the safety of their
participants, and are strongly encouraged to use good judgment when a possible threat exists.

Weather Impact on Activities
Occasionally, camp program and activities will be impacted by weather events. In particular the
Aquatics area are often the first to be impacted. Thunder & lightning in the vicinity of camp can cause
us to “delay” or “cancel” these activities. We do not take your safety lightly! Decisions to close an area
are usually determined by the area director, in consultation with the Camp Director.

As always, we depend on our unit leaders to be aware of any weather activity that they deem may
impact the safety of their participants. If you as a leader determine that you need to move your
participants from an area, or move off an activity field, we encourage you to do that and not wait for a
decision from the Staff.

Fires
Campers and staff should be careful with fire. In the event of a fire, the camp alarm will broadcast.
Please make sure that everyone in your unit knows that when they hear the alarm, they should go
immediately to the parade grounds on the north end of camp and assemble there. Do not try to find
each other around camp. The camp administration will then provide directions about how to proceed.
An emergency drill is normally held within 24 hours of each arrival group.

Lost or Missing Person
If a youth or adult is believed to be missing, adult leaders should first confirm that the missing person
is not in the campsite, activity areas, or other common gathering places about camp. The group
should utilize the following steps: Assemble Your Group, Check Each Tent, Check Areas, then if not
found, notify a staff member immediately.

Other Emergencies
Depending upon the nature of the emergency, camp staff will communicate necessary information to
the camp, based on the nature of the threat.
CAMP POLICIES
Camp Hunt follows the National BSA policies on Youth Protection. The BSA
has adopted the following policies for the safety and well-being of its members.
These policies primarily protect youth members; however, they also serve to
protect adult leaders.

Two-Deep Leadership
Two adult leaders 21 years of age or over are required at all times while at
camp.

No One-On-One Contact
One-on-one contact between adults and youth members is not permitted. In
situations that require a personal conference, the meeting is to be conducted in
view of the other adults and youth.

Respect of Privacy
Adult leaders must respect the privacy of youth members in situations such as
changing clothes and taking showers at camp and intrude only to the extent
that health and safety requires. Adults must protect their own privacy in similar
situations.

Tenting Accommodations
Separate tenting arrangements must be provided for male and female adults as
well as for male and female youth.

Youth sharing tents must be no more than two years apart in age. Youth and
adults must tent separately. Spouses may share tents.

Group Discipline and Adult Supervision
The role of the camp staff is to provide the summer camp program and all of
the other camp infrastructure needed to ensure a safe and enjoyable stay at
camp. As with any group outing, the adult leadership of each group is
responsible for the behavior of their participants. Please help the staff focus on
program by watching your participants and being available to deal with
discipline issues should they develop.

Insurance
   •   Each group is required to carry adequate and proper liability insurance.
   •   Scouts BSA and Venturing members registered in the Crossroads of the
       West Council are already insured - so nothing is required.
   •   Please prepare to verify that each camper is protected with personal
       health insurance - ensure that policy numbers are listed on each medical
       form.
CAMP POLICIES
                             •   Groups must have two-deep leadership at all times while at camp. No
                                 exceptions!

                             •   No fireworks of any kind are permitted on camp property.

                             •   No flames, fires, or fuels of any kind are permitted inside tents.

                             •   Throwing rocks is strictly forbidden.

                             •   Personal firearms and bows are not permitted, please leave them at
     VALUABLES                   home.

Please remember to           •   All vehicles must be parked in the designated camp parking areas. Only
safeguard your valuables         authorized vehicles are allowed on the roads through camp.
while at camp.
                             •   No alcoholic beverages or illegal substances are allowed on camp
A locked vehicle in the          property.
parking lot may be used to
store your group’s
valuables.
                             •   Shoes must be worn at all times at camp and must not be open at the
                                 toe or sides. Sandals are allowed only at the showers.

                             •   No sheath knives – leave them at home.

                             •   No LASER (pens/pointers) of any kind are permitted in camp.

                             •   All guests are required to immediately check-in at the Camp Office.

                             •   Refer to the Boy Scouts of America Guide to Safe Scouting for
                                 additional policies.

   TECHNOLOGY                •   Smoking - all buildings and tents are smoke-free. There are designated
                                 smoking areas for those who smoke.
Participants are
encouraged to                •   Swimwear - participants are encouraged to wear swim wear that is
appropriately document           suited for active water sports such as swim trunks or board shorts for
and share their                  males and one-piece suits or tankinis for females.
experiences during their
stay.

Please remember, there is
no power outlets for
guests to use to charge
their devices.
CAMP
                          HUNT                                                                                               Tr apper Trails Council

                BLACK
                FOOT (L)                                                    A R A PA H O ( M ) C O M A N C H E ( L )   CREE (S)
  TO IDAHO                                                     A PA C H E ( M )
                                     PA R K I N G
                YUMA (L)
                                                                                                             CHEYENNE (L)
                                                                        BANNOCK (S)
      NORTH
   ENTRANCE

                                                                                                      CHEROKEE (M)
                                                     PA R A D E G R O U N D S
                     PA R K I N G

                                                         HANDICRAFT
                                                         AREA                              A R C H E RY
                                                                                           AREA             OLD
                                                                                                            CHAPEL

                   HOPI (S)
                                    FOX (M)         N AT U R E
                                                    AREA                      CROW (S)
                   UTE (M)

                                GOSHUTE (S)                           SEMINOLE (S)

                                                                                         SIOUX (M)

                                        OUTDOOR
               SENECA (S)                SKILLS                                   N AVA J O ( L )
                                          AREA               TA O S ( L )

                    SAUK (M)

                                                        CAMP WIDE
      SOUTH   SERVICE                                   GAMES AREA
   ENTRANCE   VEHICLES
                                                                                            WAT E R F R O N T
              ONLY
                           LODGE                                                            AREA
                                                                     B O AT
                                                                     HOUSE

                                                    SHOSHONE (L)

                                                    PAW N E E ( M )

                                                S H AW N E E ( S )

                                                M O H AW K ( S )

                                                    K I O WA ( L )
TO GARDEN
      CITY
                                         ZUNI (M)

                         REILLEY FIELD
2022 Camp Hunt Week-at-a-Glance
 Time          Monday                 Tuesday            Wednesday               Thursday                Friday           Saturday
6:30 AM                            Sunrise Canoe &      Sunrise Canoe &        Sunrise Canoe &       Sunrise Canoe &      Breakfast and
                                      Bird Walk           Polar Plunge            Bird Walk            Polar Plunge         departure
  7:30      Arrival at camp,      Breakfast and camp    Breakfast and camp    Breakfast and camp    Breakfast and camp
             check-in swim-           inspections           inspections           inspections           inspections
            checks if needed,
            and camp set up.
           Scoutmasters need
  8:30        to come to the
           Lodge to check in!
  9:00                              Flag Ceremony        Flag Ceremony          Flag Ceremony         Flag Ceremony

  9:30                             First Merit Badge    First Merit Badge      First Merit Badge       Merit Badge
                                         Session              Session                Session         Completion Time
 10:30                            Second Merit Badge Second Merit Badge Second Merit Badge
                                       Session            Session            Session
11:30 AM                          Third Merit Badge     Third Merit Badge     Third Merit Badge
                                  Session; First Year   Session; First Year   Session; First Year
                                  Camper Commando       Camper Naturalist     Camper Baywatch
                                         Corp
 12:45           Lunch                  Lunch                 Lunch                 Lunch                 Lunch

  2:00      First Merit Badge        FREE TIME             FREE TIME            FREE TIME           Waterfront Olympics
                  Session          Free time merit       Free time merit       Free time merit           @ Beach
  3:00     Second Merit Badge        badge work.           badge work.           badge work.
                Session            Waterfront open.      Waterfront open.      Waterfront open.
                                   Troop shoots at       Troop shoots at       Troop shoots at
  4:00     Third Merit Badge        archery range.        archery range.        archery range.
           Session; First Year
           Camper Pathfinder

  5:15           Dinner                 Dinner                Dinner                Dinner                Dinner

  7:00     Opening Campfire Flag Ceremony                Flag Ceremony        Flag Ceremony            Scout Master
             preparations                                                                           checkout & cobbler

  7:30      Leaders Meeting        Washakie Games         Commissoner             Honor Trail
           with Senior Patrol                               Campfire
  8:00     Leader 7:30 - 8:15                                                                         Flag Ceremony

  8:20     Camp-wide fire drill

  8:30       Flag Ceremony          Fellowship of the    Troop Activities        Troop Time          Closing Campfire
                                      Lake Guides'
                                  Induction Ceremony
  9:00     Opening Campfire

 10:30         Quiet Time             Quiet Time           Quiet Time             Quiet Time            Quiet Time

                          Please don't be late -- FOR ANYTHING. YOU'LL BE MISSING OUT!
CAMP HUNT TRAIL TO FIRST CLASS REQUIREMENT CHECKLIST
MONDAY—PATH FINDER (ORIENTEERING AREA)                             result from such weather conditions, and the appropriate
SECOND CLASS                                                       actions to take.
____3a. Demonstrate how a compass works and how to orient          FRIDAY MORNING—BAY WATCH (WATERFRONT)
a map. Use a map to point out and tell the meaning of five         TENDERFOOT
map symbols.                                                       ____4a. Show first aid for the following: Simple cuts and
____3d. Demonstrate how to find directions during the day          scrapes, Blisters on the hand and foot, Minor (thermal/heat)
and at night without using a compass or an electronic device.      burns or scalds (superficial, or first-degree), Bites or stings of
FIRST CLASS                                                        insects and ticks, Venomous snakebite, Nosebleed, Frostbite
____4b. Demonstrate how to use a handheld GPS unit, GPS            and sunburn, Choking.
app on a smartphone, or other electronic navigation system.        ____4c. Tell what you can do while on a campout or other
Use GPS to find your current location, a destination of your       outdoor activity to prevent or reduce the occurrence of injuries
choice, and the route you will take to get there. Follow that      or exposure listed in Tenderfoot requirements 4a and 4b.
route to arrive at your destination.                               SECOND CLASS
                                                                   ____6b. Show what to do for “hurry” cases of stopped
TUESDAY—COMANDO CORE (PIONEERING AREA)                             breathing, stroke, severe bleeding, and ingested poisoning.
TENDERFOOT                                                         ____6d. Explain what to do in case of accidents that require
____3a. Demonstrate a practical use of the square knot.            emergency response in the home and backcountry. Explain
____3b. Demonstrate a practical use of two half- hitches.          what constitutes an emergency and what information you will
____3c. Demonstrate a practical use of the taut-line hitch.        need to provide to a responder.
____3d. Demonstrate proper care, sharpening, and use of the        ____6e. Tell how you should respond if you come upon the
knife, saw, and ax. Describe when each should be used.             scene of a vehicular accident.
SECOND CLASS                                                       FIRST CLASS
____2f. Demonstrate tying the sheet bend knot. Describe a          ____7a. Demonstrate bandages for a sprained ankle and for
situation in which you would use this knot.                        injuries on the head, the upper arm, and the collarbone.
____2g. Demonstrate tying the bowline knot. Describe a             ____7b. By yourself and with a partner, show how to:
situation in which you would use this knot.                        Transport a person from a smoke-filled room. Transport for at
____3c. Describe some hazards or injuries that you might           least 25 yards a person with a sprained ankle.
encounter on your hike and what you can do to help prevent         ____7c. Tell the five most common signals of a heart attack.
them.                                                              Explain the steps (procedures) in cardiopulmonary
FIRST CLASS                                                        resuscitation (CPR).
____3a. Discuss when you should and should not use lashings.       ____7d. Tell what utility services exist in your home or
____3b. Demonstrate tying the timber hitch and clover hitch.       meeting place. Describe potential hazards associated with
____3c. Demonstrate tying the square, shear, and diagonal          these utilities and tell how to respond in emergency situations.
lashings by joining two or more poles.                             ____7f. Explain how to obtain potable water in an emergency.
____3d. Use lashings to make a useful camp gadget.
                                                                   FREETIME—BAYWATCH (WATERFRONT)
                                                                   (Can be done T, W, Th, or F during free time)
WED/THURSDAY—NATURALIST (NATURE AREA)                              SECOND CLASS
____4b. Describe common poisonous or hazardous plants;             ____5a. Tell what precautions must be taken for a safe swim.
identify any that grow in your local area or campsite location.    ____5b. Demonstrate your ability to pass the BSA beginner
Tell how to treat for exposure to them.                            test: Jump feet first into water over your head in depth, level
SECOND CLASS                                                       off and swim 25 feet on the surface, stop, turn sharply, resume
____4. Identify or show evidence of at least 10 kinds of wild      swimming, then return to your starting place.
animals (such as birds, mammals, reptiles, fish, or mollusks)      ____5c. Demonstrate water rescue methods by reaching with
found in your local area or camping location. You may show         your arm or leg, by reaching with a suitable object, and by
evidence by tracks, signs, or photographs you have taken.          throwing lines and objects.
FIRST CLASS                                                        ____5d. Explain why swimming rescues should not be
____5a. Identify or show evidence of at least 10 kinds of          attempted when a reaching or throwing rescue is possible.
native plants found in your local area or campsite location.       Explain why and how a rescue swimmer should avoid contact
You may show evidence by identifying fallen leaves or fallen       with the victim
fruit that you find in the field, or as part of a collection you   FIRST CLASS
have made, or by photographs you have taken. ____5b.               ____6a. Successfully complete the BSA swimmer test.
Identify two ways to obtain a weather forecast for an              ____6b. Tell what precautions must be taken for a safe trip
upcoming activity. Explain why weather forecasts are               afloat.
important when planning for an event.                              ____6c. Identify the basic parts of a canoe, kayak, or other
____5c. Describe at least three natural indicators of impending    boat. Identify the parts of a paddle or an oar.
hazardous weather, the potential dangerous events that might
CAMP HUNT TRAIL TO FIRST CLASS REQUIREMENT CHECKLIST
____6d. Describe proper body positioning in a watercraft,
depending on the type and size of the vessel. Explain the
importance of proper body position in the boat.
Swim Check Certification
  Instructions:
                                                                                   • Complete 1 of the following:
  • This form is to be used by units attending Scout Camps, High
                                                                                       ✦ Swimmer test (S):
    Adventure Bases, and Treks.
                                                                                           • Jump feet first into water over the head in depth, level off,
  • Fill out the unit contact information, and list all participants that will
                                                                                               and begin swimming.
    attend camp (youth & adults).
                                                                                           • Swim 75 yards in a strong manner using one or more of the
  • The swim classification (swim check) is a key element of Safe Swim
                                                                                               following strokes: side, breast, trudgen, or crawl.
    Defense & Safety Afloat. All persons participating in BSA aquatic
                                                                                           • Swim 25 yards using any resting back stroke.
    activities will be classified according to their swimming ability. The swim
                                                                                           • The 100 yards total must be done continuously and include
    check allows individuals to demonstrate the minimum level of swimming
                                                                                               at least one sharp turn.
    skill consistent with circumstances while in the water.
                                                                                           • After completing the test, rest by floating.
  • The swim classification should be renewed annually. When swim
                                                                                       ✦ Beginner test (B):
    checks are conducted away from resident camp or at the point of
                                                                                           • Jump feet first into water over the head in depth, level off,
    activity, the BSA certified aquatics director has the authority to review or
                                                                                               and begin swimming.
    retest all participants to ensure standards have been maintained.
                                                                                           • Swim 25 feet on the surface, stop, turn sharply, and resume
  • The swim check should take place in a maximum 12 foot depth body of
                                                                                               swimming as before.
    water. During the swim check, the swimmer must be within 25 feet of
                                                                                           • Return to starting place.
    shallow water footing or pool/pier edge.
                                                                                       ✦ Non Swimmer (N):
  • Administration of Swim Check: 1) Completed on the first day of resident
    camp by aquatics personnel, 2) Completed on the unit level and                         Unit Leader Signature
    conducted by a BSA aquatics instructor, aquatics supervisor, BSA
    lifeguard, certified lifeguard, swimming instructor or coach, or unit
    leader.                                                                                Who performed your swim check? Circle one:
                                                                                               • Aquatics instructor, BSA lifeguard, certified lifeguard
                                                                                               • Swimming instructor, swim coach
                                                                                               • Swimming/Lifesaving merit badge counselor, unit leader

Unit # _________ Camp: _________________ Camp Date: _______________________

Unit Leader Name (First & Last): ___________________________________________________________
Mailing address: ________________________________________ City: ________________ State: _____
ZIP: ________________ Phone: ( ___ ) ________________ Email: ______________________________

Name           Swim Class                           Name           Swim Class                      Name           Swim Class
_________________ S B N                            _________________ S B N                        _________________ S B N
_________________ S B N                            _________________ S B N                        _________________ S B N
_________________ S B N                            _________________ S B N                        _________________ S B N
_________________ S B N                            _________________ S B N                        _________________ S B N
_________________ S B N                            _________________ S B N                        _________________ S B N
_________________ S B N                            _________________ S B N                        _________________ S B N
_________________ S B N                            _________________ S B N                        _________________ S B N
_________________ S B N                            _________________ S B N                        _________________ S B N
_________________ S B N                            _________________ S B N                        _________________ S B N
_________________ S B N                            _________________ S B N                        _________________ S B N
_________________ S B N                            _________________ S B N                        _________________ S B N
_________________ S B N                            _________________ S B N                        _________________ S B N
_________________ S B N                            _________________ S B N                        _________________ S B N
Camp Parking Pass
Leader _____ Visitor _____ Staff _____

Owner/Driver Name _______________________________________________

Unit #/Group Name ______________________

Campsite _______________________________

Arrival Date _______ / _______ / _______

Phone # ________________________________

Park in designated parking areas only. Driving in camp is prohibited except by
special permission. Parking in campsites is prohibited. Vehicles improperly
parked and vehicles without a properly displayed parking pass may be towed at
owners risk and expense. Crossroads of the West Council is not responsible for
loss or damage to the vehicle or its contents.

             DISPLAY THIS PASS IN THE DRIVER SIDE WINDSHIELD.

                                 Camp Parking Pass
Leader _____ Visitor _____ Staff _____

Owner/Driver Name _______________________________________________

Unit #/Group Name ______________________

Campsite _______________________________

Arrival Date _______ / _______ / _______

Phone # ________________________________

Park in designated parking areas only. Driving in camp is prohibited except by
special permission. Parking in campsites is prohibited. Vehicles improperly
parked and vehicles without a properly displayed parking pass may be towed at
owners risk and expense. Crossroads of the West Council is not responsible for
loss or damage to the vehicle or its contents.

             DISPLAY THIS PASS IN THE DRIVER SIDE WINDSHIELD.
Transportation
                                                Checklist
                                                The safety of our Scouts, volunteers, employees, and communities
                                                is our top priority. This two part SAFE Transportation Checklist and
                                                Pre-Trip Transporting Inspection is designed to help you manage
                                                the risks associated with transporting Scouts.

Date: _____________________ Destination: _________________________________________________________________________________

Supervision—Youth are supervised by qualified and trustworthy adults who set the example for safety.
   Two-deep leadership for duration of trip

Assessment—Activities are assessed for risk during planning.
   Route is planned.
   Passenger list is planned for trip, both to and from destination.
   Breaks are planned.
   Drive time is no more than 10 hours within a 24-hour period.
   Meets or exceeds vehicle liability insurance minimums.
   Passengers have seats with factory-installed seat belts.
   Weather/environment contingencies and communications are planned.
   If operating a 15-passenger van, manufacture date is after 2005.

Fitness and Skills—Leaders have prerequisite fitness and skill to operate vehicle.
   Driver Annual Health and Medical Records are reviewed.
   Driver is an adult, age 18 or over.
   Driver has a valid driver’s license, a commercial license if applicable.
   Driver understands expectation to follow all applicable traffic laws.
   Driver is rested and not fatigued.
   Driver meets training requirements to operating vehicle.

Equipment and Environment—Safe and appropriate vehicle for Scouting trip. Leaders Inspect vehicles
and monitor the environment for changing conditions.
   Vehicle inspection completed.
   Tires on each vehicle are no more than 6 years old.
   Weather forecast and conditions.
   Communication plan.

If there are any incidents:
1. Take care of the injured/find a safe place.
2. Preserve and document the evidence. Take photos if appropriate.
3. Immediately complete an incident report and notify your local council.
   For more information, go to www.scouting.org/health-and-safety/incident-report/.

Resources
Guide to Safe Scouting: https://www.scouting.org/health-and-safety/gss/
SAFE: https://www.scouting.org/health-and-safety/safe/

                                                                                                                                680-696
                                                                                                                       May 2021 Revision
Pre-Trip
                                                Transportation Inspection
                                                Motor vehicles used to transport Scouts must complete
                                                Pre-Trip Transportation Inspection before travel for each
                                                driver and vehicle. This includes correcting all deficiencies.
                                                Make copies for additional drivers and vehicles.

Driver’s Information
Driver’s License Number: ______________________________ Driver’s Phone Number: ______________________________________

Vehicle Information
Make and Model: ______________________________________________________ Year: ______________________________________
  Inspection Current             Registration Current              Insurance Current               Vehicle Inspection

Vehicle Inspection
                      Visual Inspection                       Driver Adjustments                            Operational Test
                         Cleanliness                             Pedals                                          Defrost
                         Fluid Leaks                             Steering Wheel                                  Horn
                         Loose Parts                             Mirrors                                         Brakes

                      Light Inspection                        Engine Inspection                             Tire Inspection
                         Headlights                               Oil                                            Tire Pressure
                         Brake Lights                             Radiator                                       Uneven Wear
                         Turn Signals                             Battery                                        Tread Depth
                         Emergency Flasher                        Exhaust                                        Spare Tire

Trailer Inspection
Trailer Gross Vehicle Weight: ____________________________________Trailer Tongue Weight: ________________________________
Vehicle Towing Capacity: _________________________________ Vehicle Max Tongue Weight: ________________________________
   Vehicle has capacity to pull trailer?
   Trailer overall visual inspection?
   Towing ball correct size?
   Safety chains connected?
   Trailer breakaway connected?
   Lights properly working, including taillights, clearance lights, brake lights, directional signals, hazard lights, reflectors?
   Tire inspection, including spare?
   Trailer’s load is properly secured?

Commercial Driver’s License (CDL)
   Driver meets CDL requirements, including valid CDL, medical card, and drug testing program?
   Vehicle meets all federal and state CDL requirements, including IFTA and electronic trip logs?
   Pro-Trip vehicle walk-around complete by CDL standards?

Emergency
   Passengers have seats with factory installed seat belts?
   Triangle reflectors and flares?
   First-aid kit and fire extinguisher?
   Emergency water, food, blankets?
   Incident reporting forms?
   Form of communication?
                                                                                                                                          680-696
                                                                                                                                 May 2021 Revision
Part A: Informed Consent, Release Agreement, and Authorization                                                                                                                                                   A
Full name: ___________________________________________                                                                       High-adventure base participants:
                                                                                                                             Expedition/crew No.: _______________________________________________
Date of birth: _________________________________________                                                                     or staff position:___________________________________________________

Informed Consent, Release Agreement, and Authorization

I understand that participation in Scouting activities involves the risk of personal injury, including          I also hereby assign and grant to the local council and the Boy Scouts of America, as well as their
death, due to the physical, mental, and emotional challenges in the activities offered. Information             authorized representatives, the right and permission to use and publish the photographs/film/
about those activities may be obtained from the venue, activity coordinators, or your local council.            videotapes/electronic representations and/or sound recordings made of me or my child at all
I also understand that participation in these activities is entirely voluntary and requires participants        Scouting activities, and I hereby release the Boy Scouts of America, the local council, the activity
to follow instructions and abide by all applicable rules and the standards of conduct.                          coordinators, and all employees, volunteers, related parties, or other organizations associated
                                                                                                                with the activity from any and all liability from such use and publication. I further authorize the
In case of an emergency involving me or my child, I understand that efforts will be made to                     reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said
contact the individual listed as the emergency contact person by the medical provider and/or                    photographs/film/videotapes/electronic representations and/or sound recordings without limitation
adult leader. In the event that this person cannot be reached, permission is hereby given to the                at the discretion of the BSA, and I specifically waive any right to any compensation I may have for
medical provider selected by the adult leader in charge to secure proper treatment, including                   any of the foregoing.
hospitalization, anesthesia, surgery, or injections of medication for me or my child. Medical
providers are authorized to disclose protected health information to the adult in charge, camp                  Every person who furnishes any BB device to any minor, without the express or implied permission
medical staff, camp management, and/or any physician or health-care provider involved in                        of the parent or legal guardian of the minor, is guilty of a misdemeanor. (California Penal Code
providing medical care to the participant. Protected Health Information/Confidential Health                     Section 19915[a]) My signature below on this form indicates my permission.
Information (PHI/CHI) under the Standards for Privacy of Individually Identifiable Health Information,
45 C.F.R. §§160.103, 164.501, etc. seq., as amended from time to time, includes examination
findings, test results, and treatment provided for purposes of medical evaluation of the participant,           I give permission for my child to use a BB device. (Note: Not all events will include BB devices.)
follow-up and communication with the participant’s parents or guardian, and/or determination of
the participant’s ability to continue in the program activities.                                                    Checking this box indicates you DO NOT want your child to use a BB device.

(If applicable) I have carefully considered the risk involved and hereby give my informed consent                                 NOTE: Due to the nature of programs and activities, the Boy Scouts of
for my child to participate in all activities offered in the program. I further authorize the sharing                             America and local councils cannot continually monitor compliance of program
of the information on this form with any BSA volunteers or professionals who need to know of                                      participants or any limitations imposed upon them by parents or medical
medical conditions that may require special consideration in conducting Scouting activities.                                      providers. However, so that leaders can be as familiar as possible with any
                                                                                                                                  limitations, list any restrictions imposed on a child participant in connection with
With appreciation of the dangers and risks associated with programs and activities, on my                                         programs or activities below.
own behalf and/or on behalf of my child, I hereby fully and completely release and waive
any and all claims for personal injury, death, or loss that may arise against the Boy Scouts                    List participant restrictions, if any:                                  None
of America, the local council, the activity coordinators, and all employees, volunteers,
related parties, or other organizations associated with any program or activity.                                ________________________________________________________

  I understand that, if any information I/we have provided is found to be inaccurate, it may limit and/or eliminate the opportunity for participation in any event or activity. If I am participating at
  Philmont Scout Ranch, Philmont Training Center, Northern Tier, Sea Base, or the Summit Bechtel Reserve, I have also read and understand the supplemental risk advisories, including height
  and weight requirements and restrictions, and understand that the participant will not be allowed to participate in applicable high-adventure programs if those requirements are not
  met. The participant has permission to engage in all high-adventure activities described, except as specifically noted by me or the health-care provider. If the participant is under the age of 18, a
  parent or guardian’s signature is required.

  Participant’s signature: ____________________________________________________________________________________________ Date: ______________________________

  Parent/guardian signature for youth: __________________________________________________________________________________ Date: ______________________________
                                                                                        (If participant is under the age of 18)

Complete this section for youth participants only:
Adults Authorized to Take Youth to and From Events:

You must designate at least one adult. Please include a phone number.

Name: _________________________________________________________________                                         Name: _________________________________________________________________

Phone: _________________________________________________________________                                        Phone: _________________________________________________________________

Adults NOT Authorized to Take Youth to and From Events:

Name: _________________________________________________________________                                         Name: _________________________________________________________________

Phone: _________________________________________________________________                                        Phone: _________________________________________________________________

                                                                                                                                                                                                                 680-001
                                                                                                                                                                                                             2019 Printing
Part B1: General Information/Health History                                                                                                                                 B1
Full name: ___________________________________________                                                          High-adventure base participants:
                                                                                                                Expedition/crew No.: _______________________________________________
Date of birth: _________________________________________                                                        or staff position:___________________________________________________

Age: ____________________________ Gender: __________________________ Height (inches): ___________________________ Weight (lbs.): ____________________________

Address: _________________________________________________________________________________________________________________________________________

City: ___________________________________________State: ____________________________ ZIP code: __________________                         Phone: ______________________________

Unit leader: ____________________________________________________________________________ Unit leader’s mobile #: _________________________________________

Council Name/No.: _______________________________________________________________________________________________________Unit No.: ____________________

Health/Accident Insurance Company: ________________________________________________________ Policy No.: ___________________________________________________

        Please attach a photocopy of both sides of the insurance card. If you do not have medical insurance, enter “none” above.

In case of emergency, notify the person below:

Name: ______________________________________________________________________________Relationship: ___________________________________________________

Address: _________________________________________________________________ Home phone: _________________________ Other phone: _________________________

Alternate contact name: _________________________________________________________________ Alternate’s phone: ______________________________________________

Health History
Do you currently have or have you ever been treated for any of the following?
  Yes      No                                 Condition                                                                             Explain
                  Diabetes                                                              Last HbA1c percentage and date:                            Insulin pump: Yes   No

                  Hypertension (high blood pressure)
                  Adult or congenital heart disease/heart attack/chest pain (angina)/
                  heart murmur/coronary artery disease. Any heart surgery or
                  procedure. Explain all “yes” answers.
                  Family history of heart disease or any sudden heart-related
                  death of a family member before age 50.
                  Stroke/TIA

                  Asthma/reactive airway disease                                        Last attack date:

                  Lung/respiratory disease

                  COPD

                  Ear/eyes/nose/sinus problems

                  Muscular/skeletal condition/muscle or bone issues

                  Head injury/concussion/TBI

                  Altitude sickness

                  Psychiatric/psychological or emotional difficulties

                  Neurological/behavioral disorders

                  Blood disorders/sickle cell disease

                  Fainting spells and dizziness

                  Kidney disease

                  Seizures or epilepsy                                                  Last seizure date:

                  Abdominal/stomach/digestive problems

                  Thyroid disease

                  Skin issues

                  Obstructive sleep apnea/sleep disorders                               CPAP: Yes      No

                  List all surgeries and hospitalizations                               Last surgery date:

                  List any other medical conditions not covered above

                                                                                                                                                                                 680-001
                                                                                                                                                                             2019 Printing
Part B2: General Information/Health History                                                                                                                                                         B2
Full name: ___________________________________________                                                          High-adventure base participants:
                                                                                                                Expedition/crew No.: _______________________________________________
Date of birth: _________________________________________                                                        or staff position:___________________________________________________

Allergies/Medications
DO YOU USE AN EPINEPHRINE                     YES         NO                                              DO YOU USE AN ASTHMA RESCUE                     YES        NO
AUTOINJECTOR? Exp. date (if yes) ___________________________                                              INHALER? Exp. date (if yes) ___________________________________

Are you allergic to or do you have any adverse reaction to any of the following?

  Yes      No         Allergies or Reactions                            Explain                        Yes      No           Allergies or Reactions                                  Explain

                   Medication                                                                                            Plants

                   Food                                                                                                  Insect bites/stings

List all medications currently used, including any over-the-counter medications.
    Check here if no medications are routinely taken.                                If additional space is needed, please list on a separate sheet and attach.

                   Medication                             Dose                     Frequency                                                              Reason

     YES        NO          Non-prescription medication administration is authorized with these exceptions: ________________________________________________________________
Administration of the above medications is approved for youth by:
_______________________________________________________________________ / _______________________________________________________________________
                                      Parent/guardian signature                                                      MD/DO, NP, or PA signature (if your state requires signature)

           Bring enough medications in sufficient quantities and in the original containers. Make sure that they are NOT expired, including inhalers and EpiPens. You SHOULD NOT STOP taking
           any maintenance medication unless instructed to do so by your doctor.

Immunization
The following immunizations are recommended. Tetanus immunization is required and must have been received within the last 10
years. If you had the disease, check the disease column and list the date. If immunized, check yes and provide the year received.          Please list any additional information about your
                                                                                                                                           medical history:
  Yes      No        Had Disease                           Immunization                                   Date(s)
                                                                                                                                           _________________________________________
                                      Tetanus
                                                                                                                                           _________________________________________
                                      Pertussis
                                                                                                                                           _________________________________________
                                      Diphtheria
                                                                                                                                           _________________________________________
                                      Measles/mumps/rubella

                                      Polio                                                                                                 DO NOT WRITE IN THIS BOX.
                                                                                                                                            Review for camp or special activity.
                                      Chicken Pox
                                                                                                                                            Reviewed by: ___________________________________________
                                      Hepatitis A
                                                                                                                                            Date: _________________________________________________
                                      Hepatitis B
                                                                                                                                            Further approval required:       Yes               No
                                      Meningitis
                                                                                                                                            Reason: _______________________________________________
                                      Influenza
                                                                                                                                            Approved by:____________________________________________
                                      Other (i.e., HIB)
                                                                                                                                            Date: _________________________________________________
                                      Exemption to immunizations (form required)

                                                                                                                                                                                                        680-001
                                                                                                                                                                                                    2019 Printing
Part C: Pre-Participation Physical
This part must be completed by certified and licensed physicians (MD, DO), nurse practitioners, or physician assistants.
                                                                                                                                                                                                       C
Full name: ___________________________________________                                                              High-adventure base participants:
                                                                                                                    Expedition/crew No.: _______________________________________________
Date of birth: _________________________________________                                                            or staff position:___________________________________________________

           You are being asked to certify that this individual has no contraindication for participation in a Scouting experience. For individuals who will be attending a high-adventure program,
           including one of the national high-adventure bases, please refer to the supplemental information on the following pages or the form provided by your patient. You can also visit
           www.scouting.org/health-and-safety/ahmr to view this information online.

Please fill in the following information:
                                              Yes    No                                                                         Explain

 Medical restrictions to participate

  Yes      No         Allergies or Reactions                            Explain                           Yes      No        Allergies or Reactions                              Explain

                    Medication                                                                                            Plants

                    Food                                                                                                  Insect bites/stings

           Height (inches)                           Weight (lbs.)                                 BMI                                Blood Pressure                                 Pulse
                                                                                                                                                /

                           Normal         Abnormal         Explain Abnormalities                Examiner’s Certification
                                                                                                I certify that I have reviewed the health history and examined this person and find no contraindications for
 Eyes                                                                                           participation in a Scouting experience. This participant (with noted restrictions):

                                                                                                   True         False                                           Explain
 Ears/nose/throat
                                                                                                                        Meets height/weight requirements.

 Lungs                                                                                                                  Has no uncontrolled heart disease, lung disease, or hypertension.
                                                                                                                        Has not had an orthopedic injury, musculoskeletal problems, or orthopedic
                                                                                                                        surgery in the last six months or possesses a letter of clearance from his or her
 Heart                                                                                                                  orthopedic surgeon or treating physician.
                                                                                                                        Has no uncontrolled psychiatric disorders.
 Abdomen
                                                                                                                        Has had no seizures in the last year.

                                                                                                                        Does not have poorly controlled diabetes.
 Genitalia/hernia
                                                                                                                        If planning to scuba dive, does not have diabetes, asthma, or seizures.

 Musculoskeletal
                                                                                                Examiner’s signature: _______________________________________ Date: _______________

 Neurological                                                                                   Examiner’s printed name: _________________________________________________________

                                                                                                Address: _______________________________________________________________________
 Skin issues
                                                                                                City: ______________________________________State: ______________ ZIP code: _________
 Other                                                                                          Office phone: ___________________________________________________

Height/Weight Restrictions
If you exceed the maximum weight for height as explained in the following chart and your planned high-adventure activity will take you more than 30 minutes away from an emergency vehicle/
accessible roadway, you may not be allowed to participate.
Maximum weight for height:

   Height (inches)            Max. Weight             Height (inches)             Max. Weight              Height (inches)           Max. Weight                 Height (inches)           Max. Weight
          60                        166                      65                       195                          70                     226                             75                   260
          61                        172                      66                       201                          71                     233                             76                   267
          62                        178                     67                        207                          72                     239                             77                   274
          63                        183                     68                        214                          73                     246                             78                   281
          64                        189                     69                        220                          74                     252                      79 and over                 295

                                                                                                                                                                                                      680-001
                                                                                                                                                                                                  2019 Printing
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