SPADE RANCH SPADE RANCH HIGH ADVENTURE CAMP AT ARIZONA'S CAMP GERONIMO PARENT GUIDE
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Grand Canyon Council BSA
Council Service Center
8840 E Chaparral Rd Suite 200
Scottsdale, AZ 85250
(602) 955-7747
SPADE RANCH
SPADE RANCH HIGH ADVENTURE CAMP
AT ARIZONA’S CAMP GERONIMO
PARENT GUIDE
SPADE RANCH
CONTENT
PROGRAM SUMMARY AND CAMP CURRICULUM 3
SESSION DATES AND PRICING 5
CAMP DETAILS AND CHECK-IN 6
PACKING LIST 7
HEALTH AND MEDICAL 9
CAMP SAFETY 10
APPENDIX: COVID-19 “AT-RISK” CAMP PARTICIPANT STATEMENT 11
APPENDIX: A HEALTHY CAMP BEGINS AND ENDS AT HOME 13
APPENDIX: MODEL COVID-19 PRE-EVENT MEDICAL SCREENING CHECKLIST 14
APPENDIX: PRESCRIPTION MEDICATION DOUSING FORM 15
Camp Geronimo’s Spade Ranch High Adventure Camp / Parent Guide 2021 2
SPADE RANCH HIGH ADVENTURE CAMP
SPADE RANCH ADVENTURE AT ARIZONA’S CAMP GERONIMO
OUR AIM IS TO CULTIVATE A LIFELONG LOVE • Modern Stand-up Paddle-boarding has its
OF THE OUTDOORS AND HIGH ADVENTURE roots in Hawaii and modern paddlers use them
THROUGH SPADE RANCH. for everything from Yoga to surfing. Spend
In order to develop character, citizenship, and per- some time learning about SUP on the Geron-
sonal fitness, young people need the opportunity imo Lake. Interested youth can even earn the
to push past their comfort zones in real world set- BSA Paddle-boarding Award.
tings that help them understand who they are and • Natural Rock Climbing and Canoeing at Blue
envision who they can become. High adventure pro- Ridge Reservoir – If you like the feel of a climb-
grams provide crucial experiences that help young ing harness, the cool touch of natural rock, and
people clarify their values, goals and vision for the the taste of sweat as adrenalin pumps through
future. The Spade Ranch High Adventure Program your system, then this is the program for you.
is designed for youth 14 and older. Our expert staff In the cool morning participants will practice
will guide youth through a variety of outdoor expe- basic climbing skills and spend the afternoon
riences emphasizing safety and skill development. canoeing in the reservoir
Join us at Camp Geronimo for an unforgettable • Mountain Biking - Participants will have an
summer experience! introductory class on the principles and tech-
niques of Mtn Biking including short and
long rides through and on trails around Camp
Geronimo.
• Horseback riding - Participants will have the
CAMP EXPERIENCES WILL INCLUDE:
opportunity to go on an out-of-camp, overnight
• Caving - Participants will explore one of the camping horseback ride. They will experience
many caves located along the Mogollon Rim. the entire process of retrieving the horse from
Be prepared to get muddy as you experience to- the field to tacking and saddling it up to feed
tal darkness, learn about cave formations, and and personal care.
practice low impact caving techniques.
• Challenge Course - Participants will have the
• Canyoneering—Canyoneering is the explo- opportunity to enhance their team building and
ration of a canyon from point A to B using a leadership skills with interactive activities and
range of techniques including hiking, swim- cable-to-pole elements (Low COPE Course).
ming, climbing, rappelling, scrambling, sliding,
and stemming. Our group will challenge itself
in the Christopher Creek box canyon and spend
the day learning about multiple pitch rappels
and climbing and swimming through beautiful
waterfalls.
Camp Geronimo’s Spade Ranch High Adventure Camp / Parent Guide 2021 3
SPADE RANCH HIGH ADVENTURE CAMP
SPADE RANCH ADVENTURE AT ARIZONA’S CAMP GERONIMO
YOUR WEEK AT SPADE RANCH
Sunday —
Arrive at camp between 1 and 4:30 to meet our staff
and go through the check-in process. Please be sure
to bring all the required paperwork! Our staff will
guide you to your campsite and help you get settled
in before heading to the pool for the BSA Swimmer
Test.
BSA Swim Test
Jump feet first into water over the head in depth.
Level off and swim 75 yards in a strong manner us-
ing one or more of the following strokes: sidestroke,
breaststroke, trudgen, or crawl; then swim 25 yards
using an easy resting backstroke. The 100 yards must
be completed in one swim without stops and must
include at least one sharp turn. After completing the
swim, rest by floating.
Monday-Friday —
Your schedule will depend upon which activity your
group will be doing that day. All the activities will
start after breakfast, so be prepared and bring all the
items necessary for that day’s activity. There will be
a one out-of-camp experience.
Friday night after closing campfire —
Pack all belongings and prepare for Saturday morn-
ing checkout. Check to make sure you received any
patches and/or documentation for the week’s ac-
complishments. Complete the camp evaluation and
reserve your spot for next year.
Camp Geronimo’s Spade Ranch High Adventure Camp / Parent Guide 2021 4
SESSION DATES AND PRICING
SPADE RANCH ADVENTURE AT ARIZONA’S CAMP GERONIMO
SESSION DATES REFUND POLICY
Spade Ranch will run for 8 sessions. Select one of In case of the death of an immediate family member,
the dates below and register at: sickness, or injury prior to attending camp, or mili-
https://www.azoutdoored.org/ tary transfer we will refund all but $150 of fees paid
when verified by a physician, military commander,
Session #1: May 30 – June 5 or such official. Participants that leave camp during
the session, for any reason, will not receive a refund.
Session #2: June 06 – June 12 Our Council Camps strive to provide the very best
program. We sign contracts with staff and vendors
Session #3: June 13 – June 19 (Sold Out) in February. Reservation cancellations after May 1st
undermine our ability to provide this quality pro-
Session #4: June 20 – June 26 (Sold Out) gram. Reasons such as vacation schedule, summer
school, and last-minute changes of mind are not ac-
Session #5: June 27 – July 3 ceptable reasons for refunds.
Session #6: July 04 – July 10
Session #7: July 11 – July 17
Session #8: July 18 – July 24
PRICING
Spade Ranch High Adventures costs $500 and
includes the following:
• Meals and lodging at Camp Geronimo
• Expert instruction and all program gear
• Program patch
Participants not registered in Scouting will need
to pay a one-time membership fee of $100 that in-
cludes general liability, secondary health insurance
coverage, and access to the many programs offered
by the scouting program.
Camp Geronimo’s Spade Ranch High Adventure Camp / Parent Guide 2021 5
CAMP DETAILS AND CHECK-IN
SPADE RANCH ADVENTURE AT ARIZONA’S CAMP GERONIMO
CAMP GERONIMO’S HOUSING AND DINING CHECK-IN
Camp Geronimo is located north of Payson in the All participants should arrive at Camp Geronimo
shadows of the magnificent Mogollon Rim on near- on Sunday between 1:00pm and 4:00pm. A colored
ly 200 acres of forest and meadows. Facilities may be wristband will be provided for each participant
viewed at: www.azoutdoored.org during check-in. These serve as a meal ticket and
identifier.
Due to the COIVD-19 pandemic, we are requesting that
all participants bring a tent for the week. If your son or
Participants will need to bring the following
daughter does not have a tent, please let us know and we
forms: All participants must submit a personal annual
will provide one for you.
health and medical record upon arrival at camp.
The Sodexo Hospitality Group provides all meals at
the Geronimo Dining Hall. The menu is approved
by a dietitian and can be found here.
MAILING INFORMATION 1. BSA Health and Medical Record: Annual
Mail is delivered to camp once a day. Post mail 3-5 Health and Medical Record
days in advance of camp arrival day to ensure a timely 2. A copy of the Family Insurance Card
delivery. For all mail:
attached to the medical form.
Youth Name - Session #
3. Prescription Medication Dousing Form
CAMP GERONIMO - SPADE RANCH
2599 W. Webber Creek Road - Filled out for any medications that are
Payson, AZ 85541 brought to camp.
CAMP CONTACT INFORMATION 4. COVID At Risk Statement
Camp Geronimo 5. Pre-event Medical Screening Checklist
2599 W. Webber Creek Road 6. Special Needs: Please notify our staff at
Payson, AZ 85541
Emergency Contact Number: 928-474-4688 gcc.program@scouting.org if your child
Sunday: 1:00pm – 4:30pm (Check in) has food allergies or other special needs.
Monday - Friday: 8:00am – 11:50am Please be sure to share this information
1:30pm – 5:00pm
Saturday: 7:00am – 10:00am (Check out) with our staff during the check-in process.
CHECK-OUT
Service Center Office
8840 E Chaparral Rd. Ste. 200 Parents are welcome to pick their son or daughter
Scottsdale, AZ 85250 after 4:00 pm on Friday, but participants are wel-
Monday - Friday: 9:00am – 5:00pm come to stay until Saturday morning and watch the
For registration questions call 602-955-7747 Friday night closing campfire. Please be at camp
Saturday morning before 10:00 am. Let the staff
Trading Post know when you plan to pick your child up during
The trading post will be open at convenient hours Check-in.
every day during camp. The Trading Post will carry
camp t-shirts, patches, souvenirs, merit badge pam- Your last stop is the Headquarters to receive your
phlets, craft supply materials, soft drinks, candy, and health forms, patches, and check out information.
a wide selection of outdoor supplies.
Camp Geronimo’s Spade Ranch High Adventure Camp / Parent Guide 2021 6
PACKING LIST
SPADE RANCH ADVENTURE AT ARIZONA’S CAMP GERONIMO
PACKING CAMP PACKING CHECK LIST
Preparing for camp is an easy process, but it does LABEL EVERYTHING
require planning ahead. The following check list is
designed to guide so you are comfortable at camp. CLOTHING:
5 tee shirts
PLEASE LEAVE AT HOME:
Fleece or wool vest or jacket
• Gaming devices, or expensive electronics
Rain jacket
• Matches, lighters, hot sparks
2 shorts
• Laser pointers
Swimsuit
• Bicycles
• Fireworks One pair long pants
• Alcoholic beverages or illegal drugs, smoking Socks and underwear
devices or vapes Wide brimmed hat
• Sheath knives 2 pairs of shoes—tennis shoes, hiking shoes
• Personal firearms or projectile items such as Sandals for the shower house or lake
wrist rockets
• Pets – Service dogs always welcome! PERSONAL ITEMS:
Bandanna
LOST PROPERTY Towel and wash cloth
Prior to arriving at camp, encourage youth to clearly Toiletries: toothbrush, paste, brush/comb,
mark all personal items with their name. This will soap, shampoo, deodorant, insect repellent,
help return items to them before departure. Lost and and feminine hygiene products.
Found is in Camp HQ. Any items left at camp will
be stored at our Council Service Center for 30 days Shaving gear
and then donated to the local charities. Reusable water bottle
Flashlight
Lip balm
Sunscreen
Sunglasses—Polarized
Waterproof watch
Sleeping Bag
Cot or Sleeping Pad
Day pack
Tent
Spending money for Trading Post
Camp Geronimo’s Spade Ranch High Adventure Camp / Parent Guide 2021 7
PACKING LIST
SPADE RANCH ADVENTURE AT ARIZONA’S CAMP GERONIMO
SPECIFIC GEAR NEEDED FOR SPADE RANCH
ADVENTURE:
HORSEBACK RIDE/CAMPING CANYONEERING
More instructions will be given on site if an overnight ride The water in the canyon is cold, please bring a swim suit
is possible. – Participants will have the opportunity to and polypro (or similar non-cotton) long underwear.
go on an out-of-camp, overnight camping horseback
ride. They will experience the entire process of re- • Fleece pullover
trieving the horse from the field to tacking and sad- • Backpack with waste strap
dling it up to feed and personal care. • Dry bag or trash bag to keep gear in backpack
dry
• Pants (snug or cowboy fitting are best, baggy • Hiking water shoes or sport shoes that can get
pants will cause skin irritation problems) wet
• Sleeping bag, headlamp, etc • Change of clothes and shoes to dry hike in (min-
• Boots or closed toe shoes imum change of socks and shoes)
• $20 to buy dinner in Payson, AZ (if time, health
CAVING and community conditions permit)
Participants will explore one of the many caves
located along the Mogollon Rim. Be prepared to MOUNTAIN BIKING
get muddy as you experience total darkness, learn Participants will have an introductory class on the
about cave formations, and practice low impact cav- principles and techniques of Mtn Biking including
ing techniques. (Caving is conditional on National short and long rides through and on trails around
Speleological Society and US Forest Service Autho- Camp Geronimo.
rization) Note: Cave Mud will permanently stain
clothing. • Pants
• Closed toed shoes
• Long Pants • Sunscreen
• Long-Sleeve Shirt • Participants may bring personal biking gear and
• Change of clothes and shoes Mountain Bike if desired
• Closed-toe shoes
• Water bottle Participants may bring personal gear for any of the
• 1 Headlamp activities listed, but cannot be used until & unless it
• Trash bag passes staff inspection.
CANOEING
• Closed-toe or water shoes
• Bathing suit
• Hat
• Sunscreen
• Water Bottle
• Sunglasses
• Dry clothes and towel for ride home
Camp Geronimo’s Spade Ranch High Adventure Camp / Parent Guide 2021 8
HEALTH AND MEDICAL
SPADE RANCH ADVENTURE AT ARIZONA’S CAMP GERONIMO
HEALTH LODGE MEDICATION POLICY
The Camp Health Lodge is staffed 24 hours a day Grand Canyon Council requires that all prescrip-
by qualified medical personnel. tion and over the counter (OTC) medications be
stored under lock and key, except when in the
For insurance purposes and for the health and safety controlled presence of health care staff or Adult
of all participants, all accidents and illnesses, no mat- Leader responsible for the administration and /or
ter how minor, must be reported to the Health Lodge dispensing of medications.
and recorded. Arrangements have been made with
the local rescue squads and hospitals to handle any • Emergency medications such as inhalers,
medical emergencies. Epipen’s, and nitro should be maintained on
MEDICAL FORM the patient’s person.
• Refrigerated medications may be stored at the
Any person staying overnight must submit a Personal
Annual Health and Medical Record upon arrival at Health Lodge or in the campsite if secured
Camp. under lock and key.
• All medication should be in a container issued
Please understand that the BSA Annual Health and
Medical Record is the only medical form recognized by a pharmacist with the medication name
by Scouting—sport, military, or other medical re- and strength, the dose and dose frequency
cords may not be substituted.
clearly marked on the container.
The annual health and medical record is provided as PRESCRIPTION/MEDICATION DOSAGE FORM
a fillable PDF Annual Health and Medical Record,
and parents are encouraged to fill it out on their All participants taking medications must fill out
computer, then print the record (rather than printing the Prescription Medication Dosing Form prior to
the record and filling it out by hand). Doing this will arrival at camp.
improve the readability and accuracy of each mem-
ber’s medical information. Please bring a paper Please use one form for each participant and list the
copy with you to camp. medication, dosage, and dosage schedule shown
on the prescription.
SPECIAL NEEDS/FOOD ALLERGY REQUESTS
Please communicate special needs prior to arrival
at camp. On Sunday, any participants with special
dietary needs should visit with the dining hall staff
to discuss accommodations that the camp can make
for their diet.
Camp Geronimo’s Spade Ranch High Adventure Camp / Parent Guide 2021 9
CAMP SAFETY
SPADE RANCH ADVENTURE AT ARIZONA’S CAMP GERONIMO
WILDLIFE SAFETY YOUTH EARLY RELEASE POLICY
Youth have an opportunity to observe many types 1. Verification must be made to assure that the per-
of wildlife that includes deer, bats, raccoons, birds, son requesting release is acting as the legal parent or
skunks, turkey, snakes, coyotes, amphibians, and guardian or under the direction of the legal parent
bears. It is wise to remember that these animals are or guardian.
the permanent residents of the backcountry.
Verification may be done by the following:
Therefore, treat all animals with respect and observe
from a distance. Store all food in a secure place. • Presentation of proper identification matched
with the name listed as the legal parent or
Do not follow, feed, tease, or handle wildlife. If guardian on the youth’s medical form.
you discover a snake or an animal that is behaving
strangely, please notify the camp staff immediately. • Contact via telephone with the legal parent or
guardian. The telephone number used may be
Please leave food and sodas at home! Do not eat supplied by the Scoutmaster or obtained from
food and drinks in cabins. Make sure your youth the medical form.
keep their sleeping bags free of food smells by
changing their clothes before going to bed and 2. It is understood that any person who requests the
washing hands and faces. Please haul all bagged early release of a youth will abide by the policy set
trash to dumpsters daily. forth above and completes the early release form
prior to the release of the youth.
EMERGENCY DRILL
3. It is understood that a youth will never be released
On Sunday evening, a siren will sound signaling the to another youth under 18 years of age without verified
emergency drill. Please report to the campfire ring to permission from the legal parent or guardian.
receive an emergency briefing.
VISITING CAMP
Visitors are not allowed when the camp is operating
under Communicable Disease Protocols during the
era of COVID-19.
Camp Geronimo’s Spade Ranch High Adventure Camp / Parent Guide 2021 10APPENDIX
SPADE RANCH ADVENTURE AT ARIZONA’S CAMP GERONIMO
COVID-19 “At-Risk” Camp Participant Statement
Your safety and the safety of all our members, volunteers, and employees is the Grand Canyon Council’s
top priority. While there is still much uncertainty regarding COVID 19, we are monitoring the information
provided by health experts and government agencies to help keep safe those who choose to come to camp
this summer.
First, our Council Staff and Health Supervisor are coordinating with state and local health departments to
ensure we are informed of and comply with their guidance to maximize health and safety of all participants.
Our camp health plan includes:
• Pre-attendance education
• Voluntary isolation 14-days prior to arrival
• Health screening conducted by your unit leadership prior to travel to our camp, including a temperature
check. Health screening upon your arrival at camp conducted by our camp health officers, which will
also include a temperature check.
• Note: should anyone in the unit not pass the arrival screening, the entire unit will not be allowed to
enter camp.
• Daily Health Screening before breakfast.
• Limitations on visitors in camp.
• We highly discourage leadership swaps during the week
• Only participants and vendors will be admitted into the camp
• All visitors are required to call the camp office to schedule an arrival time and pre-check
appointment to be conducted upon arrival and before entry into camp.
• Extra hand washing/sanitizer stations throughout camp.
• Dedicated staff to clean and disinfect high-touch surfaces and shared program equipment.
• An enhanced emergency response plan that includes an isolation and quarantine protocol should a
person at camp develop symptoms of COVID-19 or other communicable disease.
These precautions are important, but these efforts cannot completely eliminate exposure to all viral or other
illness-causing factors while at camp. Many people who contract viral illnesses may be asymptomatic, but
can still spread their illness. It is possible that someone carrying a viral infection but exhibiting no outward
symptoms could pass the required health screenings and be allowed into camp.
We also know the very nature of camp makes social distancing difficult in many situations and impossible
in others.
While individuals who contract viral infections may be asymptomatic (don’t show any signs of being sick).
Some will exhibit the following symptoms:
Page 1 of 2 / COVID-19 “At-Risk” Camp Participant Statement AZ
Camp Geronimo’s Spade Ranch High Adventure Camp / Parent Guide 2021 11• Cough
• Shortness of breath or difficulty breathing
• Fever
• Chills
• Muscle pain
• Sore throat
• New loss of taste or smell
Children have similar symptoms to adults and generally have mild illness. This list is not all inclusive. Other
less common symptoms have been reported, including gastrointestinal symptoms like nausea, vomiting, or
diarrhea and even death.
Information from the Centers for Disease Control and Prevention (CDC) states that older adults and peo-
ple of any age who have serious underlying medical conditions are at higher risk for severe illness from
COVID-19. If you are in this group, please ensure you have approval from your health care provider prior
to attending camp.
Every staff member, volunteer, and Scouting family has to evaluate their unique circumstances and make an
informed decision before attending camp. We hope this information will be helpful as you make that choice.
Please sign below indicating that you have read this statement and reviewed the attached documents. By
signing you are indicating that you or your child:
1. Completed parts A and B of the Health Record within 7 days prior to departing for camp. Part C should
be completed and signed by a medical professional within the prior year.
2. Will complete the Pre-Screening Checklist prior to departure and will not go to camp if pre-screened out.
3. Acknowledge that if you or your child exhibits any symptoms, you will be quarantined and return home
immediately at your own expense.
4. Acknowledge that no pre-screening or social distancing program can eliminate the risk that you or your
child will contract COVID and/or bring it back home after camp.
5. Acknowledge that COVID-19 can result in death or serious illness, as explained on the CDC site.
6. Acknowledge that if you or your child cannot travel to camp or must return home, that there is no refund.
7. Waive and release your right to sue the Grand Canyon Council, its camps, staff, volunteers and your unit
leaders should you or your child contract COVID.
Name of youth Parent or Guardian Signature
AZ Outdoor Ed
Date
Attachment; 2
A Healthy Camp Begins and Ends at Home
Pre-event Medical Screening Checklist
Updated May 18, 2020
Page 2 of 2 / COVID-19 “At-Risk” Camp Participant Statement
Camp Geronimo’s Spade Ranch High Adventure Camp / Parent Guide 2021 12A HEALTHY CAMP BEGINS AND ENDS AT HOME!
A healthy camp really does start at home.
Here are some actions you can take to help your child have a great camp experience.
1. If your child is sick, stay at home - If your child is showing signs of illness such as running a temperature,
throwing up, has diarrhea, nasal drainage and/or coughing/sneezing, keep the child home. This reduces
the spread of illness at camp and supports your child’s recovery. Know your camp’s policy about illness
and camp attendance.
2. A Scout is clean - Teach your child to sneeze/cough in his/her sleeve and to wash his/her hands often
while at camp, especially before eating and after toileting. If you really want to achieve impact, teach
your child to accompany hand washing with another behavior: keeping their hands away from their face.
3. Let us know how we can support your child’s health needs - If your child has mental, emotional, or
social health challenges, talk with a camp representative before camp starts. Proactively discussing a
camp’s ability to accommodate a child can help minimize – if not eliminate – potential problems.
4. Inform us of any unique nutritional needs ahead of time - Should your child need a particular nutrition
plan because of allergies, intolerances or a diagnosis (e.g., diabetes), note these on the Health History
form but also contact the camp to make sure (a) they have noted that need and (b) the camp can address
it. Discuss how your child will receive appropriate meals and snacks then explain that to your camper.
Should your child be uncomfortable with the plan, arrange for a camp staff member to assist/monitor
the process until the child is comfortable.
5. Pack closed toed shoes - Make sure your child has and wears appropriate closed toed shoes for activities
such as soccer and hiking, and that your child understands that camp is a more rugged environment than
home. Talk with your child about wearing appropriate shoes to avoid slips, trips and falls that, in turn,
can result in injuries such as sprained ankles.
6. Dress in layers - Send enough clothes so your child can dress in layers. Mornings can be chilly and after-
noons get quite warm. Dressing in layers allows your child to remove clothing as s/he warms while still
enjoying camp.
7. Be well rested before and during camp - Fatigue plays a part in both injuries and illnesses – and camp is
a very busy place! If your child is going to a day camp, be sure they get enough rest at night. If the child
will be at a resident camp, explain that camp is not like a sleepover; they need to sleep, not stay up all
night!
8. “Be Prepared” for sun protection - Remember to send sunscreen appropriate to the camp’s geographic
location and that your child has tried at home. Teach your child how to apply his/her sunscreen and how
often to do so.
9. Bring a reusable water bottle - Instruct your child to use it and refill it frequently during their camp stay.
Staying hydrated is important to a healthy camp experience, something your child can assess by noting
the color of their urine (“pee”); go for light yellow.
10. Help your youth understand who to talk to if they have a concern - Talk with your child about telling
their leaders, Health Officer, the nurse, or camp director about anything that is troublesome for them at
camp. These leaders can be quite helpful as children learn to handle being lonesome for home or cope
with things such as losing something special. These helpers can’t be helpful if they don’t know about the
problem – so talk to them.
11. Let us know how we can help - Should something come up during the camp experience or afterward
–– contact the camp’s representative and let them know. Camps want to partner effectively with parents;
sharing information makes this possible.
Page 1 of 1 / A Healthy Camp Begins and Ends at Home!
Camp Geronimo’s Spade Ranch High Adventure Camp / Parent Guide 2021 13Model COVID-19 Pre-Event Medical Screening Checklist
Use this checklist to assist in identifying potential COVID-19 cases before event participation.
Review with each youth and adult participant their current health status, both before departure and upon
arrival at the event. Anyone entering a camp or event – including visitors, vendors, etc. – Must be screened.
Yes No Have you or has anyone in your household been in close contact* in the past 14 days with
anyone known or suspected to have COVID-19 or is otherwise sick?
Yes No Have you or has anyone in your household been in close contact* with anyone who has
been tested for COVID-19 and is waiting for results?
Yes No Have you or has anyone in your household been sick in the past 14 days, or have you or
they been tested for any illness and are waiting for results?
Yes No Have you or has anyone you have been in close contact* with traveled on a cruise ship or
internationally or to an area with a known communicable disease outbreak in the past 14
days?
*According to the Centers for Disease Control and Prevention (CDC), “close contact” means:
• You were within 6 feet of someone who has COVID-19 for a cumulative total of 15 minutes or
more over a 24-hour period
• You had direct physical contact with an infected person (hugged or kissed them)
• You shared eating or drinking utensils
• An infected person sneezed, coughed, or otherwise got respiratory droplets on you
If the answer is YES to any one of the four questions above, the participant must stay home.
If all answers above are NO, proceed to the symptoms list below
Symptoms of COVID-19
If anyone in your household has any one of the following new or worsening signs or symptoms of possible
COVID-19, the entire household must stay home.
Shortness of breath Repeated shaking with chills Sore throat
Cough Fatigue Loss of taste or smell
Fever of 100.0º or greater Muscle or body aches Diarrhea
Flu-like symptoms Abnormal Headaches Nausea or vomiting
*Potential Higher-Risk Individuals*
Yes No Are you in a higher-risk category as defined by the CDC guidelines, including older adults,
people with medical conditions, and those with other individual circumstances?
If the answer is “yes,” we recommend that you stay home.
Should you choose to participate, you must have approval from your health care provider.
Name of youth Signature of Adult Performing Pre-check
AZ Outdoor Ed
Date
Updated 12/20
Page 1 of 1/ Model COVID-19 Pre-Event Medical Screening Checklist
Camp Geronimo’s Spade Ranch High Adventure Camp / Parent Guide 2021 14Prescription Medication Dosing Form
Grand Canyon Council – Boy Scouts of America
Name of Participant: ________________________________________________________________________ Age: _________ Unit Number: _______________
Summer Camp Session/Date: ______________________________________________ Campsite: ___________________________________________________
Instructions:
• Each participant taking medications should have a separate form
• Ideally, the form should be completed by the Adult planning to administer the medication.
• List each prescription medication the Scout is receiving separately.
• The unit health officer giving the medication should put their name or initials by the time at which the medication was given. If no medication is given, leave
the space blank.
Medication Name and frequency of Medication given Medication given Medication given Medications given
administration listed on the bottle around Breakfast around Lunch around Supper at bedtime
(7 - 8 AM) (12 - 1 PM) (6 PM)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Camp Geronimo’s Spade Ranch High Adventure Camp / Parent Guide 2021
NOTE: If a Scout is receiving more than three medications, use an additional form.
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