Each Scout and adult participant staying in camp more than 23 hours or anyone planning on participating in any camp program must have a completed medical form on file at the Camp Health Lodge.
BSA requires a physical evaluation be completed annually for adults and Scouts attending resident camps. A health form signed by a licensed health care provider and dated within one year of the month attending camp must be on file at the camp’s medical facility. The form is good through the last day of the month the physical was done, one year later. The current BSA Annual Health and Medical Record, a three part (A, B and C) medical history and physical evaluation form, is required for all Scouts and adults attending resident camp. Additionally, Connecticut Yankee Council added an addendum to meet Connecticut DPH regulations. Together, these parts make up the Connecticut Yankee Council Health Form that will allow your Scouts and adult participants to attend Camp Sequassen. The CYC Addendum is required for all campers under 18 years of age to receive over-the-counter (OTC) drugs and products for the routine treatment of minor ailments and injuries and for issuing preventative topicals such as sunscreen.
Once the CYC Health Form is completed, it should be provided to the unit leader so they can send it to the Camp Nurse no later than two week prior to your unit’s arrival at Camp Sequassen. Any additional medical forms or any medication your participants will need during their session at Camp Sequassen, should be turned into the Health Lodge at their scheduled time upon arrival on Sunday.
This page is filled out by participant and parent/guardian
– This is the first page where you will see at the top that you are required to fill out the participants full name and date of birth. This is required on all pages of the BSA Health Form.
– The High-Adventure base participants box is not required to be fill out out.
– In the middle of the page you will see highlighted in green that the participant is required to sign the page with the date.
– Also in the middle of the page the parent/guardian of the participant if they are under the age of 18 at any part of their stay at Camp Sequassen are required to sign the page with the date.
– The bottom part of the page authorizes certain adults to take youth participants off Camp Sequassen property. This typically should include some or all of the adult leaders that will be staying with your unit during a week of camp.
– This is the second page where you will see at the top that you are required to fill out the participants full name and date of birth. This is required on all pages of the BSA Health Form.
– The High-Adventure base participants box is not required to be fill out out.
– All other parts of this page should be filled out. No other parts of this page can be left blank.
This page is filled out by parent/guardian or participant over the age of 18 and medical providers signature
– This is the third page where you will see at the top that you are required to fill out the participants full name and date of birth. This is required on all pages of the BSA Health Form.
– The High-Adventure base participants box is not required to be fill out out.
– All other parts of this page should be filled out. No other parts of this page can be left blank.
– In the center of the page the parent’s/guardian’s signature is required again highlight in yellow.
– Also in the center of the page if the participant takes medication the medical provider’s signature is required highlight in blue. This is required for all in and out of state participants. A stamped signature is not acceptable.
– This is the fourth page where you will see at the top that you are required to fill out the participants full name and date of birth. This one part of the page can be filled out parent/guardian or participant.
– The High-Adventure base participants box is not required to be fill out out.
– All other parts of this page should be filled out by the medical provider. No other parts of this page can be left blank.
– On the center-right of the page the medical provider’s signature is required highlight in blue.
A stamped signature is not acceptable.
This page is filled by parents/guardians
– This page is not required for adult participants (18+).
– Please be sure to review this page in its full.
– All parts of this page should be filled out. No parts of this page can be left blank.
– On the bottom of the page the parent’s/guardian’s signature is required highlight in yellow.
– All parts of this page should be filled out by the medical provider. No parts of this page can be left blank.
– On the bottom of the page the medical provider’s signature is required highlight in blue.
