BSA AHMR Part C

Please check everything before you leave the doctor's office:

• This form is required if you go on any outing longer than 72 hours (e.g. summer camp)

• This form requires a medical exam.  Please schedule it well ahead of the outing.  More information may be found here.

• The form is valid for one year from the date of the doctor's signature.

  • Go to this link, and print only Page 4.  

• This will be one page, printed single sided, with the other side left blank.

• Older versions of Part C are not accepted by camps.

• Fill out name and date of birth on the top.  Take the form to the doctor.

• Doctor fills out everything including

  • Medical restrictions to participate

  • Allergies

  • Height, weight, blood pressure and pulse

  • Eyes/ears etc. (on the left, all bullets)

  • Certification (above signature, all bullets except last two)

    • Scuba one if applicable

    • High adventure one (last) if applicable

  • Date and signature (many forms are turned in without the doctor noting the date - it can not be used)

• Return a copy (not the original) to the Troop - keep the original with you