Family Insurance Information
Dear Scoutmaster and Parent:
Attach a copy of this form to the medical form of each Scout and Scouter
coming to the Buckskin Scout Reservation.
If my child/ward becomes sick while attending one of the camps at the
Buckskin Scout Reservation, I give permission for the camp’s health officer to
issue the following non-prescription medications in standard label dosage
according to age.
| Medication |
Dose |
Medication |
Dose |
Medication |
Dose |
| Milk of Magnesia |
|
Donnagel |
|
Tinactin |
|
| Tylenol |
|
Calamine |
|
Benedryl |
|
| Pepto Bismol |
|
Sore throat |
|
Mylanta |
|
Insurance coverage:
To keep fees as low as possible the Buckskin Council provides medical
insurance for all registered Scouts and Scouters for the Buckskin Council
Only. Out of Council units must provide proof of insurance at the time of
check-in at camp. The primary policy will be the youth/adults own family
medical coverage. Medical forms must list the insurance carrier of the
participant and the policy number.
The camp can neither provide nor purchase prescription medications. Local
pharmacies will accept parent's credit card charges.
Include with the medical form a photocopy of both sides of the card for
your child's primary insurance carrier. If unavailable, we need: the insurance
company and policy number, the group sponsoring the insurance, the
verification number, the name of the policy (which parent), and where to send
the claim forms.
Insurance Co:________________________________
Policy #:___________________________
Group: _____________________________________
Verification #: ______________________
Name on the policy: ___________________________
Soc. Security # ______________________
Address where to send claims:
While we have an excellent safety record, outdoor living and activities like:
swimming, boating, climbing, and hiking have inherent risks. We've had cuts,
sprains, and broken bones. We have safety rules that must be obeyed, and safety
equipment that must be worn. Scouts are expected to behave responsibly. The
scout agrees to adhere to the camp rules; the parent gives permission for the
Scout to participate.
Youths Name (print): _______________________________
Signature:______________________________
Parents Name (print): _______________________________
Signature:______________________________
|