Medical form rangers 08-2009

SOUTH CAROLINA DISTRICT ROYAL RANGERS
ACTIVITY AUTHORIZATION/EMERGENCY MEDICAL INFORMATION AND AUTHORIZATION
(PLEASE PRINT. ALL INFORMATION IS REQUIRED. INCLUDE AREA CODE FOR ALL PHONE NUMBERS)
Use this form for Royal Rangers under age 18 - Commanders use the Commanders Medical Form Medical Questionnaire
Is your child presently being treated for any injury or sickness?.
Is he taking any form of medication for any reason? …………… Is your child allergic to any type of medication? ………………… Is your child allergic to latex?……………………………………….
Has your child ever had an operation? …………………………… Does your child require a special diet?…………………………….
Does your child have any allergies? ……………………………… Does your child ever sleepwalk? ………………………………….
Does your child get nervous or upset easily? …………………….
Is your child current on his immunizations?…………………….
Does your child have, or has he ever had, any of the following (circle all that apply): Does your child have any physical handicap that would prevent him from participating in normal or rigorous activity? you may have answered on the above section: If your child requires a specific medication, send specific instructions on how often and how much. The medication and instructions should be given to his commander. Basic first aid will be administered to your child as needed. In addition, some over the counter medications may be administered to your child with your permission. These medications may be available through a registered nurse or a Please complete the opposite side of this form.
Do you want to be notified before your child is given any over-the-counter medication? Please draw a line through any medication you DO NOT want your child to receive.
Other Information
Please provide any other information you believe we may need for the proper treatment of your child, should the need Medical Treatment Authorization
has my permission to participate in any sanctioned activity of and/or the South Carolina District Royal Rangers provided he is properly supervised by authorized commanders (adult leaders). Such activities would include field trips, campouts, ball games, swimming (if allowed by parent), and any other normal scouting activity.
I understand that all necessary precautions have been taken for the safety of my child and that I will be notified in the case of an emergency or injury. I authorize the calling of a doctor and the providing of medical services/treatment in the case of an accident, injury or sickness, by a licensed health care provider, if for any reason I cannot be contacted or present. I understand that the church or the South Carolina District Royal Rangers will not take care of medical expenses incurred; they will be my responsibility as parent/guardian.
I agree to notify the church in the event of any health changes that would restrict my child’ normal activities of the group. I also understand that the commander reserves the right to restrict my child from any activity that he does not feel is within the physical capabilities of my child.
*This form is valid for one year from date of signature.
The seal is required by the SC District Royal Rangers

Source: http://scdrr.org/forms/temp/Medical%20Form%20Rangers%2008-2009.pdf