Personal Health and Medical Record Forms

There are 3 "classes" of activities requiring medical evaluations.
Class 1 and Class 2 evaluations are on the same form; Class 3 evaluations are on a different form.

Class 1
For day camp, overnight hike, or other programs not exceeding 72 hours, (with level of activity similar to that of home or school), when medical care is readily available. Current personal health and medical summary (history) is attested by parents to be accurate. This form is filled out by all participants.
(Update annually for all participants).
Class 2
For resident camp or any other activity such as backpacking, tour camping, or recreational sports involving events lasting longer than 72 consecutive hours, (with level of activity similar to that at home or school) when medical care is readily available. Includes a physical examination; see below for more details.
(Required once every 36 months for all participants under 40 years of age).
Class 3
This is used for all taking part on high adventure activities. This is also used for adults over 40 years of age. A physical examination no older than 12 months is required.

If your child has had a medical evaluation (physical examination) within the last 36 months, a copy of the results of this examination must be attached to the health history for all participants in a camping experience lasting longer than 72 consecutive hours (3 days and nights). If a copy is not available, a physical examination (using the Class 2 section of this form) must be scheduled by a * licensed medical practitioner. This medical evaluation (physical examination) also is required if your child is currently under medical care, takes a prescribed medication, requires a medically prescribed diet, has had an injury or illness during the past 6 months that limited activity for a week or more, has ever lost consciousness during physical activity, or suffered a concussion from a head injury.

* In addition to examinations conducted by medical doctors and doctors of osteopathy, examinations will be recognized if conducted by doctors of chiropractic, physician's assistants, or pediatric nurse practitioners only in states where they may perform physical examinations on students enrolled in public school systems.

PDF format

PDF forms can be printed with the Adobe Acrobat Reader. Download Adobe Acrobat Reader