Wapashuwi Lodge 56 WTGC Guide

Table of Contents

Introductory Letters Outdoor Code Wapashuwi 56 Lodge Information BSA Tour Plan and Medical Forms GWRC Camping: Camp Stigwandish and Camp Stambaugh Scout Council Camps:

o Ohio o Pennsylvania o New York o Canada

Ohio State Parks Hiking Trails Trail Food Suppliers and Hiking Tips High Adventure Unique Camping Opportunities Leave No Trace information and Award Applications Addition and Feedback Forms

Scouts, Scouters, and Community Members, The Order of the Arrow is known as Scoutings National Honor Society, and the Brotherhood of Cheerful Service. An integral part of membership, and the mission of The Order is to Promote camping, responsible outdoor adventure, and environmental stewardship as essential components of every Scouts experience, in the unit, year-round, and in summer camp. This Where to Go Camping Guide is intended to aid in fulfilling this purpose of the OA, and Scouting as a whole. It is my hope that the mission of Scouting, The Order, and our Lodge can be fulfilled through your use of this publication. Robert Baden-Powell is famously quoted as saying Scouting is outing. This is absolutely true, and I have long held the deep-rooted belief that camping is truly where the magic happens, with regard to a youths scouting experience. In the outdoors, skills come alive; nature is seen in a new light, and all scouting participants grow in regard for each other and the world around them. If your Pack, Troop, Team, or Crew needs to improve its camping experiences with respect to quality and/or frequency, look no further than this guide. We are lucky and blessed to live in a fantastic part of the country for outdoor experiences, with many opportunities available within an hours drive. In the OH-PA-NY area exists many further opportunities of equal quality, as well! Be sure to explore the opportunities around you, and good luck! You may add to this guide by filling out the form at the end, or by contacting the Lodge, my adviser, Mr. Fortuna or myself. Happy camping! Yours in Scouting Brotherhood, Noah John Boksansky Eagle Scout, Troop 99 Newbury, OH Camping Promotion Chairman, Wapashuwi 56 ------------------------------------------------------------------------------------ Lodge Email: [email protected] Camping Promotion Chairman, Noah Boksansky: [email protected] Camping Promotion Adviser, Ken Fortuna: [email protected] Lodge Website: www.wapashuwi.org GWRC #463 Council Website: http://bsa-gwrc.org

Scouter, This manual has been assembled to help expand the adventures in your scouting units. With the help of the facilities listed within, you can promote more camping and hiking in your unit throughout the year. Have your scouts explore the outdoors and take in the wonders it has to offer. Teach your scouts how wonderful it is to see nature in action. To watch the plants, animals and the trees work together as one. Take advantage of what is listed. Not only will the scouts learn from it but, as leaders, we will also learn. Remind your scouts to treat the outdoors with respect. Remember to use the Outdoor Code and Leave no Trace principles to preserve the outdoors for future generations. I would like to thank all of the Troops, Leaders and Scouts who have shared there special outdoor camping spot. I hope the new leaders as well as the veteran leaders find the guide useful. Maybe you will even find a new place that you can take your units and start a new tradition. If you have a place you would like to have in this manual, please forward the information and I will be sure to add it to the camping guide. Send it to [email protected]

HAPPY CAMPING

OUTDOOR CODE As an American I will do my best to ! Be clean in my outdoor manners

I will treat the outdoors as a heritage. I will take care of it for myself and others. I will keep my trash and garbage out of lakes, streams, fields, woods, and roadways.

Be careful with fire

I will prevent wildfire. I will build my fires only where they are appropriate. When I have finished using a fire, I will make sure it is cold out. I will leave a clean fire ring, or remove all evidence of my fire.

Be considerate in the outdoors

I will treat public and private property with respect. I will use low-impact methods of hiking and camping.

Be conservation minded

I will learn how to practice good conservation of soil, waters, forests, minerals, grasslands, wildlife, and energy. I will urge others to do the same.

Order of the Arrow

WAPASHUWI 56

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!Boy Scout Tour Plan

and Medical Forms

Tour Plan

NEW ONLINE TOUR AND ACTIVITY PLAN NOW LIVE

The new online Tour and Activity Plan through MyScouting has been developed and is now live.

For those who do not have Internet access or simply prefer paper over an electronic version, a PDF version can be found on the tour and activity plan FAQ page. (All other paper versions are obsolete as of now). However, we are encouraging everyone to use the online system.

A training video has been developed that guides you through the application process.

When compared to the former tour permit process, the new plan will no longer require signatures or approvals. Rather, as the plan is completed online, the required prerequisites for that type of trip or activity will be displayed.

For any prerequisites that have not been met (for example, not having someone on a trip who has Hazardous Weather training where this training is required), and before being allowed to submit the form, the person completing the form will have to certify that all prerequisites will be met prior to conducting the trip or activity. Once submitted, an email notification will be sent to your council, chartered organization, committee chair, unit leader, and emergency contact to let them know that a plan has been submitted. Receivers of this notification can log in to MyScouting and review the plan.

Other tour and activity plan enhancements include the following:

The local council reviews plans but does not approve them. Because email notifications will be sent once a plan has been submitted, it is important to

maintain current leadership information in the system. Links are provided to current program-required training and education. System prompts and warnings are included. You will be able to review and fix any deficiencies flagged by the system prior to submitting

the plan. You can store, retrieve, copy, and reuse completed tour and activity plans. Files such as trekking plans and flight plans may be uploaded. Unit volunteers who currently have access to the tour and activity plan will be able to view and

update all plans submitted for their unit up to the day before the scheduled tour date. There will be leader certification of the plan prior to submission.

Tour Plan

What you need to know

Before you get started, here are some details you will need to have ready:

Attendee Checklist: Activity Checklist:

Do you have 2 adult leaders ready for this trip who are over 21 years old, or an assistant adult leader whose minimum age is 18 (or 21 if a Venturing crew)?

Has at least 1 adult on the trip completed Youth Protection Training in the last 2 years?

Is the ratio of adults to youth at 1 adult per 10 or fewer youth?

If this tour includes a Co-ed Venturing Crew, is there at least 1 adult female?

If traveling by car, do you know the make/model/year and have insurance information for the vehicles to be used?

Do you have a signed Activity Consent and Approval Form for each youth on the trip?

If this trip includes a pack overnighter, has at least 1 adult attending completed Basic Adult Leader Outdoor Orientation (BALOO)?

If your activity includes swimming or boating, has at least 1 adult attending completed Safe Swim Defense and Safety Afloat in the last 2 years?

If your activity includes climbing, has at least one adult attending completed Climb on Safely in the last 2 years?

If your activity includes wilderness or backcountry, has at least 1 adult attending completed Wilderness First Aid in the last 2 years?

Has at least 1 adult on the trip completed Planning and Preparing for Hazardous Weather in the last 2 years?

If your activity includes Orientation Flights, has a Fly Plan been completed?

1TOUR AND ACTIVITY PLANDate __________________________________________________________________________

Pack Troop/team Crew/Ship Contingent unit/crew Unit No. _________ Chartered organization __________________________________________Council name/No. ________________________________________________/_______________District _________________________________________________________________________Description of tour or activity ______________________________________________________From (city and state) ______________________________to _____________________________Dates _________________________ to ________________________ Total days ____________Itinerary: It is required that the following information be provided for each day of the tour. (Note: Speed or excessive daily mileage increases the possibility of accidents.) Attach an addi-tional page if more space is required. Include detailed information on campsites, routes, and !oat plans, and include maps for wilderness travel as required by the local council.

DateTravel

Mileage Overnight stopping place (Check if reservations are cleared.)From To

Type of trip: Day trip Short-term camp (less than 72 hours) Other (OA Weekend, etc.) _________________________________ Long-term camp (longer than 72 hours) High-adventure activities High-adventure base____________________

Party will consist of (number):____ Youthmale ____ Youthfemale____ Adultsmale ____ Adultsfemale

Party will travel by (check all that apply): Car Bus Train Plane Van Boat Other ______________________________________________________________

Leadership and Youth Protection Training: Boy Scouts of America policy requires at least two adult leaders on all BSA activities. Coed Venturing crews must have both male and female leaders older than 21 for overnight activities. All registered adults must have completed BSA Youth Protection training. At least one registered adult who has completed BSA Youth Protection training must be present at all events and activities. Youth Protection training is valid for two years from the date completed. Adult leader responsible for this group (must be at least 21 years old):

Name ____________________________________ Age _______ Scouting position _________________________________________________

Address __________________________________________________________________________________ Member No. ________________

City __________________________________________________________ State _______________ Zip code ___________________________

Phone _______________________________ Email ___________________________________ Youth Protection training date ______________

Assistant adult leader name(s) (minimum age 18, or 21 for Venturing crews):

Name ____________________________________ Age _______ Scouting position _________________________________________________

Address __________________________________________________________________________________ Member No. ________________

City __________________________________________________________ State _______________ Zip code ___________________________

Phone _______________________________ Email ___________________________________ Youth Protection training date ______________Attach a list with additional names and information as outlined above.

Our travel equipment will include a "rst-aid kit and a roadside emergency kit.

The group will have in possession an Annual Health and Medical Record for every participant.

We certify that appropriate planning has been conducted using the Sweet 16 of BSA Safety, quali"ed and trained supervision is in place, permissions are secured, health records have been reviewed, and adult leaders have read and are in possession of a current copy of Guide to Safe Scouting and other appropriate resources. Any items needing attention will be resolved before the tour or activity date.

Signature: Committee chair or chartered organization representative Signature: Adult leader

Unit single point of contact (not on tour)

Name ____________________________________Phone __________________Email_________________________________________________

For o#ce use

Tour and activity plan No. ____________Date received _______________________Date reviewed ______________________

Council stamp/signatures

NoahNote: Please use the online version of this form if your unit has access to MyScouting. This greatly expedites the approval process

Noah

Noah

Noah

2Tour involves: Swimming Boating Climbing Orienta hts (attach Flying Plan required) Wilderness or backcountry (must carry Wilderness Use Policy and follow principles of Leave No Trace) Shooting Other (specify) Activity Standards: Where swimming or boating is included in the program, Safe Swim Defense and/or Safety A oat are to be followed. If climbing/rappelling is included, then Climb On Safely must be followed. At least one person must be current in CPR/AED from any recognized agency to meet Safety A at and Climb On Safely guidelines. At least one adult on a pack overnighter must have completed Basic Adult Leader Outdoor Orientation (BALOO). At least one adult must have completed Planning and Preparing for Hazardous Weather training for all tours and activities. Trek Safely and Basic First Aid are recommended for all tours, and Wilderness First Aid is recommended for all backcountry tours.

Expiration date of commitment card/training (two years from completion date)

Name Age Youth Protection

Planning and Preparing

for Hazardous Weather

BALOO(no

expiration)

Climb On Safely Safe Swim Defense

Safety A at

Name Age CPR Cer ation/Agency CPR Expiration Date

First-Aid Cer ation/Agency First Aid Expiration Date

Name Age NRA Instructor and/or RSO

No. _______ R Shotgun Pistol (Venturing only) Range Safety O cer Muzzle-loading r Muzzle-loading shotgun

No. _______ R Shotgun Pistol (Venturing only) Range Safety O cer Muzzle-loading r Muzzle-loading shotgun

Unauthorized and Restricted Activities: The BSAs general liability insurance policy provides coverage for bodily injury or property damage that arises out of an o cial Scouting activity as d ned by the Guide to Safe Scouting. Volunteers, units, chartered organizations, and local councils that engage in unauthorized activities are jeopardizing their insurance coverage. PLEASE DO NOT PUT YOURSELF AT RISK.INSURANCEAll vehicles MUST be covered by a liability and property damage insurance policy. The amount of this coverage must meet or exceed the insurance requirement of the state in which the vehicle is licensed and comply with or exceed the requirements of the country of destination for travel outside the United States. It is recommended, however, that coverage limits are a $100,000 combined single limit. Any vehicle designed to carry 10 or more passengers is required to have a $500,000 combined single limit. In the case of rented vehicles, the requirement of coverage limits can be met by combining the limits of personal coverage carried by the driver with coverage carried by the owner of the rented vehicle.

If the vehicle to be used is designed to carry more than 15 people (including the driver), the driver must have a valid commercial drivers license (CDL). In some states (California, for example), this policy applies to drivers of vehicles designed to carry 10 or more people.

All vehicles used in travel outside the United States must carry a public liability and property damage liability insurance policy that complies with or exceeds the requirements of that country. Attach an additional page if more space is required.

Name ___________________________________________________________ CDL expires ___________________________________________

Name ___________________________________________________________ CDL expires ___________________________________________

680-014 2011 Printing Rev. 12/2011

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VALID DRIVERSLICENSE(Y or N)

LIABILITY INSURANCE COVERAGE

Combined Single Limit

Guide to Tour Planning Principles

Policy on Use of the Annual Health and Medical RecordIn order to provide better care for its members and to assist them in better understanding their own physical capabilities, the Boy Scouts of America recommends that everyone who participates in a Scouting event have an annual medical evaluation by a certified and licensed health-care providera physician (MD or DO), nurse practitioner, or physician assistant. Providing your medical information on this four-part form will help ensure you meet the minimum standards for participation in various activities. Note that unit leaders must always protect the privacy of unit participants by protecting their medical information.

Parts A and B are to be completed at least annually by participants in all Scouting events. This health history, parental/guardian informed consent and release agreement, and talent release statement is to be completed by the participant and parents/guardians. Attach a copy of both sides of your insurance card.

Part C is the pre-participation physical exam that is required for participants in any event that exceeds 72 consecutive hours, for all high-adventure base participants, or when the nature of the activity is strenuous and demanding. Service projects or work weekends may fit this description. Part C is to be completed and signed by a certified and licensed heath-care providerphysician (MD or DO), nurse practitioner, or physician assistant. It is important to note that the height/weight limits must be strictly adhered to when the event will take the unit more than 30 minutes away from an emergency vehicle, accessible roadway, or when the program requires it, such as backpacking trips, high-adventure activities, and conservation projects in remote areas. See the FAQs for when this does not apply.

Part D is required to be reviewed by all participants of a high-adventure program at one of the national high-adventure bases, as well as unit-based, high-adventure backcountry activities, and shared with the examining health-care provider before completing Part C.

s Philmont Scout Ranch. Participants and guests for Philmont activities that are conducted with limited access to the backcountry, including most Philmont Training Center conferences and family programs, will not require completion of Part C. However, participants should review Part D to understand potential risks inherent at 6,700 feet in elevation in a dry Southwest environment. Please review specific registration information for the activity or event.

s Northern Tier National High Adventure Base.s Florida National High Adventure Sea Base. The PADI medical

form is also required if scuba diving at this base.

s Summit Bechtel Reserve.

Annual Health and Medical RecordRegistro Mdico y de Salud Anual

(Valid for 12 calendar months)(Vlido por 12 meses calendario)

Poltica para el uso del Registro Mdico y de Salud AnualA fin de proporcionar una mejor atencin para sus miembros y para ayudarles a entender mejor sus propias capacidades fsicas, Boy Scouts of America recomienda que todos aquellos que participen en un evento Scouting se sometan a un examen mdico anual realizado por un prestador de servicios de salud certificado y con licencia: un mdico (Doctor en medicina o Doctor en osteopata), enfermera profesional o asistente mdico. Proporcionar su informacin mdica en este formulario de cuatro partes, ayudar a asegurar que usted cumple con los estndares mnimos de participacin en varias actividades. Tome en cuenta que los lderes de unidad siempre deben proteger la privacidad de los participantes al salvaguardar su informacin mdica.

Las Partes A y B las deben completar, por lo menos una vez al ao, los participantes de todos los eventos Scouting. Este historial mdico, notificacin de consentimiento y convenio de exoneracin de responsabilidad por parte de los padres/tutores, y formulario de cesin de derechos lo deben completar los participantes y los padres/tutores. Anexar una copia de ambos lados de su tarjeta del seguro.

La Parte C es el examen fsico previo, que se requiere de los participantes de cualquier evento que exceda 72 horas consecutivas, para todos los participantes de las bases de aventura extrema, o cuando la naturaleza de la actividad es extenuante y exigente. Los proyectos de servicio o fines de semana de trabajo pueden caer en esta descripcin. La Parte C la debe completar y firmar un prestador de servicios de salud certificado y con licencia: un mdico (Doctor en medicina o Doctor en osteopata), enfermera profesional o asistente mdico. Es importante tomar en cuenta que los lmites de estatura y peso deben ser estrictamente controlados cuando el evento llevar a la unidad a ms de 30 minutos de un vehculo de emergencia, camino accesible, o cuando el programa lo requiera, tal como expediciones, actividades de aventura extrema y proyectos de conservacin en reas remotas. Consulte las Preguntas Frecuentes para cuando estos lineamientos no aplican.

La Parte D se requiere que la revisen todos los participantes del programa de aventura extrema en una de las bases nacionales de aventura extrema, as como actividades de aventura extrema en zonas aisladas basadas en la unidad, y que la compartan con el prestador de servicios de salud antes de completar la Parte C.

s Rancho Scout Philmont. Los participantes e invitados en las actividades Philmont que se realicen con acceso limitado a las zonas campestres, incluyendo la mayora de las conferencias y programas familiares en el Centro de Capacitacin Philmont, no requerirn llenar la Parte C. Sin embargo, los participantes debern repasar la Parte D para entender los riesgos potenciales inherentes a los 6,700 pies de elevacin en un ambiente seco del Suroeste. Favor de revisar la informacin de registro especfica para la actividad o evento.

s Base nacional de aventura extrema Northern Tier. s Base nacional marina de aventura extrema de la Florida.

Tambin se requiere el formulario mdico PADI si se va a bucear en esta base.

s Summit Bechtel Reserve.

Risk FactorsBased on the vast experience of the medical community, the BSA has identified the following risk factors that may limit your participation in various outdoor adventures.

For more information on medical risk factors, visit Scouting Safely on www.scouting.org.

PrescriptionsThe taking of prescription medication is the responsibility of the individual taking the medication and/or that individuals parent or guardian. A leader, after obtaining all the necessary information, can agree to accept the responsibility of making sure a youth takes the necessary medication at the appropriate time, but the BSA does not mandate or necessarily encourage the leader to do so. Also, if state laws are more limiting, they must be followed.

Frequently Asked Questions (FAQs)s 0HILMONT 3COUT 2ANCH www.philmontscoutranch.org or

575-376-2281s .ORTHERN 4IER .ATIONAL (IGH !DVENTURE 0ROGRAM

www.ntier.org or 218-365-4811s &LORIDA .ATIONAL (IGH !DVENTURE 3EA "ASE

www.bsaseabase.org or 305-664-5612s .ATIONAL 3COUT JAMBOREE www.bsajamboree.orgs 3UMMIT "ECHTEL 2ESERVE www.summitblog.org or

304-250-6750

For frequently asked questions about this Annual Health and -EDICAL 2ECORD SEE 3COUTING 3AFELY ONLINE AT http://www.scouting.org/scoutsource/HealthandSafety.aspx. Information about the Health Insurance Portability and Accountability Act (HIPAA) may be found at www.hhs.gov/ocr/privacy/.

s Excessive body weights Heart diseases Hypertension (high blood

pressure)s Diabetess Seizuress Lack of appropriate

immunizations

s Asthmas Allergies/anaphylaxiss Muscular/skeletal

injuriess Psychiatric/

psychological and emotional difficulties

Factores de riesgoCon base en la gran experiencia de la comunidad mdica, BSA ha identificado los siguientes factores de riesgo que podran limitar su participacin en varias aventuras al aire libre.

Para obtener ms informacin sobre los factores de riesgo mdicos, visite Scouting Safely en www.scouting.org.

PrescripcionesTomar los medicamentos prescritos es responsabilidad del individuo que requiere el medicamento o del padre de familia o tutor del individuo. Un lder, despus de haber obtenido toda la informacin necesaria, puede aceptar la responsabilidad de asegurarse de que un nio tome el medicamento necesario a la hora apropiada, pero BSA no obliga ni necesariamente anima al lder a que lo haga. Asimismo, si las leyes estatales son ms limitantes, deben ser cumplidas.

Preguntas frecuentess 2ANCHO 3COUT 0HILMONT www.philmontscoutranch.org

575-376-2281s "ASE NACIONAL DE AVENTURA EXTREMA .ORTHERN 4IER

www.ntier.org 218-365-4811s "ASE NACIONAL MARINA DE AVENTURA EXTREMA DE LA &LORIDA

www.bsaseabase.org 305-664-5612s *AMBOREE 3COUT .ACIONAL www.bsajamboree.org s 3UMMIT "ECHTEL 2ESERVE www.summitblog.org

304-250-6750

0ARA CONSULTAR LAS PREGUNTAS FRECUENTES SOBRE ESTE 2EGISTROMdico y de Salud Anual, consulte Scouting Safely en lnea en http://www.scouting.org/scoutsource/HealthandSafety.aspx. La informacin sobre la Ley de responsabilidad y transferibilidad de seguros mdicos (HIPAA, por sus siglas en ingls) se encuentra en www.hhs.gov/ocr/privacy/.

s Peso corporal excesivos Enfermedad cardiaca s Hipertensin (Presin

arterial alta)s Diabetess Convulsioness Falta de vacunacin

adecuada

s Asmas Alergias/anafilaxias Lesiones musculares/

seass Trastornos psiquitricos/

psicolgicos y emocionales

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Annual Health and Medical Record Registro Mdico y de Salud AnualPart A/Parte A GENERAL INFORMATION/INFORMACIN GENERAL

Name ___________________________________________________ Date of birth __________________________________ Age ___________ Male Female Nombre Fecha de nacimiento (MM/DD/Year) - (MM/DD/Ao) Edad Masculino Femenino

Address _____________________________________________________________________________________________ Grade completed (youth only) _____________________Domicilio Grado escolar completado (slo nios)

City _________________________________________________________ State _____________ Zip _____________________ Phone No. ______________________________Ciudad Estado Cdigo postal No. telefnico

Unit leader ___________________________________________________ Council name/No. __________________________________________ Unit No. __________________Lder de la unidad Nombre y no. del concilio No. de unidad

Social Security No. (optional; may be required by medical facilities for treatment) __________________________________ Religious preference _______________________No. de Seguro Social (opcional; puede ser solicitado por las instalaciones mdicas para brindar tratamiento) Preferencia religiosa

Health/accident insurance company ___________________________________________________________ Policy No. _______________________________________________Compaa de seguro mdico/accidental No. de pliza

ATTACH A PHOTOCOPY OF BOTH SIDES OF INSURANCE CARD. IF YOU DO NOT HAVE MEDICAL INSURANCE, ENTER NONE ABOVE. ANEXAR UNA FOTOCOPIA DE AMBOS LADOS DE LA TARJETA DEL SEGURO. SI USTED NO TIENE SEGURO MDICO, ESCRIBA NINGUNO.

In case of emergency, notify/En caso de emergencia, notificar a:Name ________________________________________________________________________________ Relationship ___________________________________________________Nombre Parentesco

Address ______________________________________________________________________________________________________________________________________________Domicilio

Home phone ________________________________________ Business phone ____________________________________ Mobile phone ______________________________Telfono de casa Telfono de oficina Telfono mvil

Alternate contact name ____________________________________________________________________ Alternates phone __________________________________________Nombre de contacto alterno Telfono del contacto alterno

HEALTH HISTORY/HISTORIAL MDICO Please fill in the bubbles as indicated below:Do you currently have, or have you ever been treated for any of the following? Por favor rellene los crculos tal como se indica a continuacin:Tiene actualmente, o ha tenido alguna vez los siguientes? Incorrect: Correct: Incorrecto Correcto

Yes/S No/No Condition/Padecimiento Explain/ExpliqueAsthma Last attack: (MM/YY) Asma ltimo ataque: (MM/AA)

Diabetes Last HbA1c: (Percentage) Diabetes ltima HbA1c: (Porcentaje)

Hypertension (high blood pressure) Hipertensin (presin alta)

Heart disease/heart attack/chest pain/heart murmur Enfermedad del corazn/infarto/dolores de pecho/soplo cardaco

Stroke/TIA Apopleja/Accidente isqumico transitorio

Lung/respiratory disease Enfermedades pulmonares/respiratorias

Ear/sinus problems Problemas del odo/senos paranasales

Muscular/skeletal condition Condiciones musculares/seas

Menstrual problems (women only) Problemas menstruales (slo mujeres)

Psychiatric/psychological and emotional difficulties Dificultades psiquitricas/psicolgicas y emocionales

Behavioral/neurological disorders Trastornos de conducta/neurolgicos

Bleeding disorders Enfermedades hemorrgicas

Fainting spells Desmayos

Thyroid disease Enfermedades de la tiroides

Kidney disease Enfermedades del rin

Sickle cell disease Anemia falciforme

Seizures Last seizure: (MM/YY)Convulsiones ltima convulsin: (MM/AA)

Sleep disorders (e.g., sleep apnea) Trastornos del sueo (por ejemplo, sndrome de apnea-hipopnea durante el sueo)

Use CPAP: Yes No Usa CPAP S No

Abdominal/digestive problems Problemas abdominales/digestivos

Surgery Last surgery: (MM/YY) Ciruga ltima ciruga: (MM/AA)

Serious injury Lesin grave

Excessive fatigue or shortness of breath with exercise Fatiga en exceso o dificultad para respirar al hacer ejercicio

Other Otro

High-adventure base participants:Participantes en la base de aventura extrema:Expedition/crew No. Expedicin/grupo no.: ______________________________or staff position o puesto fijo: _____________________________________

%

PART A (continued on next page)Page 1 of 2

MEDICATIONS List all medications currently used. (If additional space is needed, please photocopy this part of the health form.) Inhalers and EpiPen information must be included, even if they are for occasional or emergency use only.

MEDICAMENTOS Enumere todos los medicamentos que usa en la actualidad. (Si requiere espacio adicional, favor de sacar una fotocopia de esta parte del formulario.) Se debe incluir informacin sobre inhaladores y EpiPen, incluso si son slo para uso ocasional o en caso de emergencia.

Administration of the above medications is approved by (if required by your state): _________________________________________________________/ _______________________________________________________La administracin de los medicamentos arriba Parent/guardian signature and/or MD/DO, NP, or PA signaturemencionados est aprobada por (si lo requiere su estado) Firma del padre o tutor y/o Firma del Dr., Enfermera profesional, Asistente mdico

Bring enough medications in sufficient quantities and in the original containers. Make sure that they are NOT expired, including inhalers and EpiPens. You SHOULD NOT STOP taking any maintenance medication unless instructed to do so by your doctor.Asegurarse de traer los medicamentos en cantidades suficientes y en los envases originales. Asegurarse de que NO ESTN CADUCADOS, incluyendo inhaladores y EpiPens. NO DEBE DEJAR DE tomar cualquier medicamento de mantenimiento a menos que se lo indique su mdico.

No medications Sin medicamentos

Additional medications (sheet attached) Medicamentos adicionales (hoja anexa)

680-001 2012 Printing

Rev. 9/2012

HEALTH HISTORY/HISTORIAL MDICO

Please fill in the bubbles as indicated: Por favor rellene los crculos tal como se indica:

Incorrect:

Correct: Incorrecto Correcto

Page 2 of 2

Yes/S No/No Allergies or Reaction to Alergias o Reacciones aExplain Explique

Medication Medicamentos

Food, plants, or insect bites Alimentos, plantas o picaduras de insectos

The following immunizations are recommended by the BSA. Tetanus immunization is required and must have been received within the last 10 years. For each item, indicate if you have been immunized, the date of the immunization (MM/YY), if you have had the disease, and the date (MM/YY). BSA recomienda las siguientes vacunas. La vacuna contra el Ttanos es obligatoria y debe haberla recibido en los ltimos 10 aos. Por cada punto, indique si ha sido vacunado, la fecha en que la recibi (MM/AA), si ha padecido la enfermedad, y la fecha (MM/AA).

Immunized? Vacunado? Immunizations

VacunasDate (MM/YY) Fecha (MM/AA)

Had Disease?La ha padecido? Date (MM/YY)

Fecha (MM/AA)Yes/S No/No Yes/S No/No

Tetanus Ttano

Pertussis Tos ferina

Diphtheria Difteria

Measles Sarampin

Mumps Paperas

Rubella Rubola

Polio Polio

Chicken pox Varicela

Hepatitis A Hepatitis A

Hepatitis B Hepatitis B

Meningitis Meningitis

Influenza Influenza

Other (i.e., HIB) Otra (por ejemplo, HIB)

Exemption to immunizations claimed (form required). Exencin de vacunas solicitada (formulario obligatorio).

Medication Medicamento _________________________________________

Strength Frequency Dosis ____________________ Frecuencia ________________

Approximate date started Fecha aproximada de inicio _____________________________

Reason for medication Razn del medicamento ________________________________

______________________________________________________





______________________________________________________





______________________________________________________





______________________________________________________





______________________________________________________





______________________________________________________

Are you allergic to or do you have any adverse reaction to any of the following?Es alrgico a, o le causa alguna reaccin adversa cualquiera de los siguientes?

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High-adventure base participants: Participantes en la base de aventura extrema:Expedition/crew No./Expedicin/grupo no.: ______________________________or staff position/o puesto fijo: ___________________________________________Part B/Parte B

INFORMED CONSENT AND RELEASE AGREEMENTI understand that participation in Scouting activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding. I also understand that participation in these activities is entirely voluntary and requires participants to abide by applicable rules and standards of conduct.

In case of an emergency involving me or my child, I understand that every effort will be made to contact the individual listed as the emergency contact person. In the event that this person cannot be reached, permission is hereby given to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for me or my child. Medical providers are authorized to disclose protected health information to the adult in charge, camp medical staff, camp management, and/or any physician or health care provider involved in providing medical care to the participant. Protected Health Information/Confidential Health Information (PHI/CHI) under the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. 160.103, 164.501, etc. seq., as amended from time to time, includes examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participants parents or guardian, and/or determination of the participants ability to continue in the program activities.

I have carefully considered the risk involved and give consent for myself and/or my child to participate in these activities. I approve the sharing of the information on this form with BSA volunteers and professionals who need to know of medical situations that might require special consideration for the safe conducting of Scouting activities.

I release the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation.

I hereby assign and grant to the local council and the Boy Scouts of America the right and permission to use and publish the photographs/film/videotapes/electronic representations and/or sound recordings made of me or my child at all Scouting activities, and I hereby release the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all liability from such use and publication.

I hereby authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said photographs/film/videotapes/electronic representations and/or sound recordings without limitation at the discretion of the Boy Scouts of America, and I specifically waive any right to any compensation I may have for any of the foregoing.

NOTIFICACIN DE CONSENTIMIENTO Y EXONERACIN DE RESPONSABILIDADEntiendo que la participacin en actividades Scouting implica un cierto grado de riesgo y que pueden ser fsica, mental y emocionalmente agotadoras. Asimismo, entiendo que la participacin en dichas actividades es completamente voluntaria y requiere que los participantes se acaten a las reglas y estndares de conducta pertinentes.

En caso de que yo, o mi hijo, nos veamos involucrados en un caso de emergencia, entiendo que se har todo lo posible para contactar al individuo mencionado como persona a contactar en caso de emergencia. En caso de que dicha persona no pueda ser localizada, por este medio otorgo permiso al proveedor de servicios mdicos seleccionado por el lder adulto a cargo para asegurar que se proporcione el tratamiento adecuado, incluyendo hospitalizacin, anestesia, ciruga o inyecciones de medicamentos para m o mi hijo. Los proveedores mdicos estn autorizados a compartir informacin mdica protegida con el adulto a cargo, el personal mdico del campamento, la administracin del campamento, o cualquier mdico o proveedor de servicios mdicos involucrado en la administracin de atencin mdica al participante. La Informacin mdica protegida/Informacin mdica confidencial (PHI/CHI, por sus siglas en ingls) bajo los Estndares de privacidad de informacin mdica individualmente identificable, 45 C.F.R. 160.103, 164.501, etc., y siguientes como se enmiendan de vez en cuando, incluye resultados de reconocimientos mdicos, resultados de pruebas y tratamiento proporcionado para propsitos de evaluacin mdica del participante, seguimiento y comunicacin con los padres o tutor del participante, y determinacin de la habilidad del participante de continuar con las actividades del programa.

He considerado cuidadosamente el riesgo implicado y he dado el consentimiento para m mismo o mi hijo de participar en dichas actividades. Apruebo que se comparta la informacin contenida en este formulario con los voluntarios y profesionales de BSA que necesiten tener conocimiento de condiciones mdicas que puedan requerir consideracin especial para la realizacin de actividades Scouting de manera segura.

Eximo a Boy Scouts of America, al concilio local, a los coordinadores de la actividad y a todos los empleados, voluntarios, grupos involucrados u otras organizaciones asociadas con la actividad, de cualquier y toda reclamacin o responsabilidad que surja a raz de esta participacin.

Por este conducto asigno y otorgo al concilio local y a Boy Scouts of America el derecho y permiso para usar y publicar las fotografas/pelculas/videocintas/representaciones electrnicas y grabaciones de sonido de m o mi hijo realizadas en todas las actividades Scouting, y por este medio exonero a Boy Scouts of America, al concilio local, a los coordinadores de la actividad y a todos los empleados, voluntarios, grupos involucrados u otras organizaciones asociadas con la actividad, de cualquier y toda responsabilidad por dicho uso y publicacin.

Por este conducto autorizo la reproduccin, venta, derechos reservados, exhibicin, transmisin, almacenamiento electrnico y distribucin de dichas fotografas/pelculas/ videocintas/representaciones electrnicas y grabaciones de sonido sin limitacin a discrecin de Boy Scouts of America, y especficamente renuncio a cualquier derecho de compensacin alguna que pueda tener por cualquiera de lo anterior.

Without restrictions./Sin restricciones.

With special considerations or restrictions (list)/Con condiciones especiales o restricciones (lista):

________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________

Yes/S

No/No

PART B (continued on next page)Page 1 of 2

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680-001 2012 Printing

Rev. 9/2012Page 2 of 2

ADULTS AUTHORIZED TO TAKE YOUTH TO AND FROM EVENTS: You must designate at least one adult. Please include a telephone number.

I understand that, if any information I/we have provided is found to be inaccurate, it may limit and/or eliminate the opportunity for participation in any event or activity.

If I am participating at Philmont, Philmont Training Center, Northern Tier, Florida Sea Base, or the Summit Bechtel Reserve: I have also read and understand the risk advisories explained in Part D, including height and weight requirements and restrictions, and understand that the participant will not be allowed to participate in applicable high-adventure programs if those requirements are not met. The participant has permission to engage in all high-adventure activities described, except as specifically noted by me or the health-care provider. If the participant is under the age of 18, a parent or guardians signature is required.

ADULTOS AUTORIZADOS PARA TRANSPORTAR AL NIO HACIA Y DESDE LOS EVENTOS:Debe designar por lo menos a un adulto. Por favor incluya un nmero telefnico.

Entiendo que, si cualquier informacin que he/hemos proporcionado es errnea, puede limitar o eliminar la oportunidad de participacin en cualquier evento o actividad.

Si participo en Philmont, el Centro de Capacitacin Philmont, Northern Tier, la Base Marina de la Florida o Summit Bechtel Reserve: Tambin he ledo y entiendo las advertencias de riesgo explicadas en la Parte D, incluyendo los requisitos y restricciones de estatura y peso, y entiendo que al participante no se le permitir intervenir en programas de aventura extrema si dichos requisitos no se cumplen. El participante tiene permiso de intervenir en todas las actividades de aventura extrema descritas, excepto aquellas especficamente sealadas por m o el proveedor de servicios mdicos. Si el participante es menor de 18 aos, se requiere la firma de el padre/madre o tutor.

1. Name/Nombre __________________________________________________________________________Telephone/Telfono ________________________



Adults NOT authorized to take youth to and from events/Adultos NO autorizados para transportar al nio hacia y desde los eventos:




Participants name/Nombre del participante _____________________________________________________________________________________________

Participants signature/Firma del participante Date/Fecha

Parent/guardians signature/Firma del padre o tutor Date/Fecha (if participant is under the age of 18/si el participante es menor de 18 aos)

Second parent/guardian signature/Firma del otro padre o tutor Date/Fecha (if required; for example, CA/si se requiere; por ejemplo en CA)

This Annual Health and Medical Record is valid for 12 calendar months. Este Registro Mdico y de Salud Anual tiene vigencia por 12 meses calendario.

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Part C/Parte C Pre-participation Physical Examen fsico previo a la participacin

TO THE EXAMINING HEALTH CARE PROVIDER (Certified and licensed physicians [MD, DO], nurse practitioners, and physician assistants)You are being asked to certify that this individual has no contraindication for participation in a Scouting experience as described in Part D. For individuals who will be attending a high-adventure program, either unit-based or at one of the national high-adventure bases, please refer to Part D for additional information.

PARA EL PROVEEDOR DE SERVICIOS DE SALUD QUE REALICE EL RECONOCIMIENTO (Mdicos certificados y licenciados, enfermeras profesionales y asistentes mdicos)Se les est solicitando que certifiquen que este individuo no tiene contraindicacin para participar en una experiencia Scouting tal como se describe en la Parte D. Para individuos que estarn participando en un programa de aventura extrema, ya sea en la unidad o en una de las bases nacionales de aventura extrema, por favor consulte la Parte D para informacin adicional.

Height (inches) Weight (pounds) Maximum weight for height Estatura (pulgadas) Peso (libras) Mximo peso para la estatura

Blood pressure Pulse Percent body fat (optional) Presin arterial Pulso Porcentaje de grasa corporal (opcional)

If you exceed the maximum weight for height as explained on the next page and your planned high-adventure activity will take you more than 30 minutes away from an emergency vehicle/accessible roadway, you will not be allowed to participate. At the discretion of the medical advisers of the event and/or camp, participation of an individual exceeding the maximum weight for height may be allowed if the body fat percentage measured by the health care provider is determined to be 20 percent or less for a female or 15 percent or less for a male. (Philmont requires a hydrostatic weighing or DXA test to be used for this determination.) Please call the event leader and/or camp if you have any questions. Enforcing the height/weight guidelines is strongly encouraged for all other events.

Si usted excede el peso mximo para su estatura tal como se explica en la siguiente pgina y su actividad de aventura extrema planeada le llevar a ms de 30 minutos de distancia de una va con acceso para un vehculo de emergencia, usted no podr participar. A juicio de los consejeros mdicos del evento o campamento, la participacin de un individuo que exceda el peso mximo para su estatura puede permitirse si el porcentaje de grasa corporal medida por el proveedor de servicios de salud determina que es 20 por ciento o menos para una mujer o 15 por ciento o menos para un hombre. (Philmont requiere que se use una prueba de peso hidrosttico o de densitometra sea para determinarlo). Por favor llame al lder del evento o del campamento si tiene preguntas. El cumplimiento de los lineamientos de estatura y peso se recomienda encarecidamente para todos los dems eventos.

Examiner: Please fill in the information. Examinador: Favor de completar la informacin.

Normal Normal

Abnormal Anormal

Explain Any Abnormalities Explique cualquier anomala

Range of Mobility Rango de movilidad

Normal Normal

Abnormal Anormal

Explain Any Abnormalities Explique cualquier anomala

Eyes Ojos

Knees (both) Rodillas (ambas)

Ears Odos

Ankles (both) Tobillos (ambos)

Nose Nariz

Spine Espina

Throat Garganta

Lungs Pulmones

Neurological Neurolgico

Other Otro

Yes S

No No

Explain Explique

Heart Corazn

Personal or family history of heart disease Historial personal o familiar de enfermedad cardaca

Abdomen Abdomen

Medical equipment (i.e., CPAP, oxygen)Equipo mdico (por ejemplo, CPAP, oxgeno)

Genitalia/hernia Genitales/hernia

Contacts Lentes de contacto

Skin Piel

Dentures Dentaduras

Emotional adjustment Ajuste emocional

Braces Tratamientos de ortodoncia

Tuberculosis (TB) skin test (if required by your state for BSA camp staff): Negative/Negativo Positive/PositivoPrueba de Tuberculosis (TB) (si lo requiere su estado para personal del campamento BSA)

Allergies/Alergias: No/No Yes/S (explain to what agent, type of reaction, treatment/explique a qu agente, tipo de reaccin, tratamiento):

___________________________________________________________________________________________________________________________________

Medical restrictions to participate/Restricciones mdicas para participar: No/No Yes/S (explain/explique):

___________________________________________________________________________________________________________________________________

Meets height/ weight limitsCumple con los lmites de estatura/peso

Yes/S No/No

High-adventure base participants:Participantes en la base de aventura extrema:Expedition/crew No. Expedicin/grupo no.: ______________________________or staff position o puesto fijo: _____________________________________


Incorrect:


Page 1 of 2 PART C (continued on next page)

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Height (inches)Estatura

(pulgadas)

Recommended Weight (lbs)

Peso recomendado (libras)

Allowable ExceptionExcepcin permitida

Maximum Acceptance

Aceptacin mxima

60 97-138 139-166 166

61 101-143 144-172 172

62 104-148 149-178 178

63 107-152 153-183 183

64 111-157 158-189 189

65 114-162 163-195 195

66 118-167 168-201 201

67 121-172 173-207 207

68 125-178 179-214 214

69 129-185 186-220 220

70 132-188 189-226 226

71 136-194 195-233 233

72 140-199 200-239 239

73 144-205 206-246 246

74 148-210 211-252 252

75 152-216 217-260 260

76 156-222 223-267 267

77 160-228 229-274 274

78 164-234 235-281 281

79 & over 170-240 241-295 295

This table is based on the revised Dietary Guidelines for Americans from the U.S. Dept. of Agriculture and the Dept. of Health & Human Services.

Esta tabla est basada en los Lineamientos dietticos para estadounidenses del Departamento de Agricultura de los EE.UU. y del Departamento de Salud y Servicios Humanos.

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DO NOT WRITE IN THIS BOXNO ESCRIBA EN ESTE RECUADRO

REVIEW FOR CAMP OR SPECIAL ACTIVITY/REVISIN PARA CAMPAMENTO O ACTIVIDAD ESPECIAL

Reviewed by Revisado por _____________________________________________________________

Date Fecha ___________________________________________________________________

Further approval required Yes NoSe requiere aprobacin adicional S No

ReasonRazn ____________________________________________________________________

Approved by Aprobado por _____________________________________________________________

Date Fecha ___________________________________________________________________

Click here for more information regarding high-adventure outings or go to www.scouting.org/filestore/HealthSafety/pdf/part_d.pdf.Haga clic aqu para obtener ms informacin sobre las excursiones de aventura extrema o visite www.scouting.org/filestore/HealthSafety/pdf/ part_d.pdf.

EXAMINERS CERTIFICATION CERTIFICACIN DEL EXAMINADOR

I certify that I have reviewed the health history and examined this person and find no contraindications for participation in a Scouting experience. This participant (with noted restrictions above):Certifico que he revisado el historial mdico, examinado a esta persona y no encuentro contradicciones para su participacin en una experiencia Scouting. Este participante (con las restricciones descritas anteriormente):

True False Cierto Falso

Meets height/weight requirements Cumple con los requisitos de estatura/peso

Does not have uncontrolled heart disease, asthma, or hypertension

No tiene cardiopata, asma o hipertensin incontrolados

Has not had an orthopedic injury, musculoskeletal problems, or orthopedic surgery in the last six months or possesses a letter of clearance from his or her orthopedic surgeon or treating physician

No ha tenido una lesin ortopdica, problemas musculoesquelticos o ciruga ortopdica en los ltimos seis meses o posee una carta de autorizacin por parte de su cirujano ortopdico o mdico

Has no uncontrolled psychiatric disorders No tiene trastornos psiquitricos incontrolados

Has had no seizures in the last year No ha tenido convulsiones en el ltimo ao

Does not have poorly controlled diabetes No tiene diabetes mal controlada

If less than 18 years of age and planning to scuba dive, does not have diabetes, asthma, or seizures

Si tiene menos de 18 aos de edad y piensa realizar buceo, no tiene diabetes, asma o convulsiones

I have reviewed Part D for high-adventure activities.

He revisado la Parte D para actividades de aventura extrema.

Provider printed name Nombre del proveedor _______________________________________________

Address Domicilio ___________________________________________________________

City, state, zip Ciudad, estado, cdigo postal ________________________________________

Office phone Telfono del consultorio ______________________________________________

Date Fecha _____________________________________________________________

Examiner signature in the box below. Firma del examinador en el recuadro de abajo.

680-001 2012 Printing

Rev. 9/2012


Incorrect:


Page 2 of 2

Part D: High-Adventure Notes to Physicians and Parents Participation at any of the BSAs high-adventure bases or in any unit high-adventure backcountry activities can be physically, mentally, and emotionally demanding. To be better prepared, each participant must complete the following before attending any high-adventure base or participating in any high-adventure backcountry activity:

s &ILL IN PARTS ! AND " OF THE !NNUAL (EALTH AND -EDICAL2ECORD

s 3HARE 0ART $ WITH THE EXAMINING HEALTHCARE PROVIDERs (AVE A PHYSICAL EXAM BY A CERTIlED AND LICENSED HEALTH

care provider/physician (MD, DO), nurse practitioner, or physician assistant, and have part C completed.

s 2EAD THE FOLLOWING INFORMATION WHICH FOCUSES ON SPECIlCrisks at the high-adventure base you will be attending.

The Trek Experience. Each high-adventure base offers a unique experience that is not risk-free. Knowledgeable staff will instruct all participants in safety measures to be followed. Be prepared to listen to and carefully follow these safety measures and to accept responsibility for the health and safety of yourself and others.

Philmont. Each participant must be able to carry a 35- to 50-pound pack while hiking 5 to 12 miles per day in an isolated mountain wilderness ranging from 6,500 to 12,500 feet in elevation. Summer/autumn climatic conditions INCLUDE TEMPERATURES FROM TO DEGREES LOW HUMIDITY(10 to 30 percent), and frequent, sometimes severe, afternoon thunderstorms. Activities include horseback riding, rock climbing and rappelling, challenge events, pole climbing, black powder shooting, 12-gauge trap shooting, .30-06 shooting, trail building, mountain biking, and other activities that have potential for injury.Winter climatic conditions can range from -20 to 60 degrees. For the Winter Adventure, each person will walk, ski, or snowshoe along snow-covered trails pulling loaded toboggans or sleds for up to 3 miles, or more on a cross-COUNTRY SKI TREK 2EFER TO THE 0HILMONT 3COUT 2ANCH WEBSITEfor specific information.

Northern Tier. Each person must be able to carry a 50- to 85-pound pack or canoe from a quarter-mile to 2 miles several times a day on rough, swampy, and rocky portages and paddle 10 to 15 miles per day, often against a headwind.Climatic conditions can range from 30 to 100 degrees in summer/autumn and from -40 to 40 degrees in the winter. For the Okpik Experience, each person will walk, ski, or snowshoe along snow-covered trails or across frozen lakes, pulling loaded toboggans or sleds for up to MILES OR MORE IF ON A CROSSCOUNTRY SKI TREK 2EFER TO THENorthern Tier website for specific information.

Florida Sea Base. Climatic conditions at Florida Sea Base INCLUDE TEMPERATURES RANGING FROM TO DEGREES HIGHhumidity, heat index reaching to 110 degrees, and frequent, sometimes severe, afternoon thunderstorms. Activities include snorkeling, scuba diving, kayaking, canoeing, sailing, hiking, and other activities that have potential FOR INJURY 2EFER TO THE 3EA "ASE WEBSITE FOR SPECIlCinformation.

Parte D: Notas para mdicos y padres de familia sobre aventura extrema La participacin en cualquiera de las bases de aventura extrema de BSA, o en cualquier actividad de aventura extrema en terrenos campestres aislados puede ser fsica, mental y emocionalmente agotadora. Para estar mejor preparado, cada participante debe completar lo siguiente antes de acudir a cualquier base de aventura extrema o de participar en cualquier actividad de aventura extrema en terrenos campestres aislados:

s #OMPLETAR LAS PARTES ! Y " DEL 2EGISTRO -DICO Y DE 3ALUDAnual.

s #OMPARTIR LA PARTE $ CON EL PROVEEDOR DE ATENCIN MDICA QUErealizar el reconocimiento.

s 3OMETERSE A UN EXAMEN FSICO POR UN PROVEEDOR DE ATENCINmdica/mdico (MD, DO), enfermera profesional o asistente mdico certificado y licenciado y que ste complete la parte C.

s ,EER LA SIGUIENTE INFORMACIN QUE SE ENFOCA EN RIESGOSespecficos en la base de aventura extrema a la que acudir.

Experiencia en las caminatas. Cada base de aventura extrema ofrece una experiencia nica que implica riesgos. El personal experto dar instrucciones a todos los participantes con respecto a las medidas de seguridad que se deben seguir. Preprese para escuchar y seguir con atencin dichas medidas y a aceptar la responsabilidad por la salud y seguridad de usted y los dems.

Philmont. Cada participante debe poder cargar una mochila con un peso de entre 35 y 50 libras en un trayecto de 5 a 12 millas por da en un ambiente montaoso, silvestre y aislado con una elevacin entre 6,500 y 12,500 pies. Las condiciones climatolgicas del verano/otoo incluyen temperaturas de LOS A LOS GRADOS POCA HUMEDAD A POR CIENTO Yfrecuentes, e incluso severas tormentas elctricas por la tarde. Las actividades incluyen montar a caballo, escalar en roca, rapel, eventos desafiantes, treparse a un mstil, disparo con plvora, tiro al vuelo de calibre 12, tiro con cartucho .30-06, senderismo, bicicleta de montaa y otras actividades que tienen posibilidades de causar lesiones.Las condiciones climticas invernales pueden abarcar de -20 a 60 grados. Para la Aventura invernal, cada persona caminar, esquiar o caminar con raquetas para nieve a lo largo de senderos cubiertos de nieve jalando trineos de carga durante tres millas de distancia o ms en un sendero para esqu a campo TRAVIESA #ONSULTE EL SITIO WEB DEL 2ANCHO 3COUT 0HILMONT PARAobtener informacin especfica.

Northern Tier. Cada persona debe poder cargar una mochila de 50 a 85 libras o una canoa entre media milla y dos millas varias veces al da en lugares escabrosos, pantanosos y rocosos y remar de 10 a 15 millas por da, con frecuencia con viento de frente.Las condiciones climticas pueden variar entre los 30 y 100 grados en el verano/otoo y de -40 a 40 grados en el invierno. Para la Experiencia Okpik, cada persona caminar, esquiar o caminar con raquetas para nieve a lo largo de senderos cubiertos de nieve o a travs de lagos congelados jalando trineos de carga durante tres millas de distancia o ms en un sendero para esqu a campo traviesa. Consulte el sitio web de Northern Tier para obtener informacin especfica.

Base Marina de la Florida. Las condiciones climticas en la Base Marina de la Florida incluyen temperaturas que van DESDE LOS HASTA LOS GRADOS HUMEDAD ELEVADA E NDICEde calor que alcanza los 110 grados y hay frecuentes e incluso severas, tormentas elctricas por la tarde. Las actividades incluyen snorkel, buceo, kayak, canotaje, vela, excursin, y otras actividades que pueden causar lesiones. Consulte el sitio web de la Base Marina para obtener informacin especfica.

Page 1 of 8 0!24 $ continued on next page)

Risk Advisory. All of the high-adventure bases have excellent health and safety records and strive to minimize risks to participants and advisors by emphasizing appropriate safety precautions. Because most participants are prepared, are conscious of risks, and take safety precautions, they do not experience injuries. If you decide to attend Philmont, Northern Tier, Florida Sea Base, or THE 3UMMIT "ECHTEL 2ESERVE YOU SHOULD BE PHYSICALLYfit, have proper clothing and equipment, and be willing to follow instructions, work as a team with your crew, and take responsibility for your own health and safety. Parents, guardians, and participants in any high-adventure program are advised that journeying to and from these bases can involve exposure to accidents, illness, and/or injury.High-adventure staff members have been trained in first aid, #02 AND ACCIDENT PREVENTION AND ARE PREPARED TO ASSIST THEadult advisor in recognizing, reacting to, and responding to accidents, injuries, and illnesses as needed. Each crew is required to have at least one member trained in wilderness lRST AID AND #02 -EDICAL AND SEARCHANDRESCUE SERVICESare provided in response to an accident or emergency. However, response times can be affected by location, terrain, weather, or other emergencies and could be delayed for hours or even days in a wilderness setting.

Philmont. Participants and guests for Philmont activities that are conducted with limited access to the backcountry, including most Philmont Training Center conferences and family programs, should review Part D to understand potential health risks inherent at 6,700 feet in elevation in a dry Southwest environment. High elevation; physically demanding high-adventure program in remote mountainous areas; camping while being exposed to occasional severe weather conditions such as lightning, hail, flash floods, and heat; and other potential problems, including injuries from tripping and falling, falls from horses, heat exhaustion, and motor vehicle accidents, can worsen underlying medical conditions. Philmonts trails are steep and rocky. Wild animals such as bears, rattlesnakes, and mountain lions are native and usually present little danger if proper precautions are taken. Please call Philmont (575-376-2281) if you have any questions.

Northern Tier. While participating in Northern Tiers canoeing and camping wilderness areas, life jackets must be worn at all times when on the water. Crew members travel together at all times. Emergency communications via radio, and in more remote locations by satellite phone, ARE PROVIDED BY .ORTHERN 4IER 2ADIO COMMUNICATION ANDor emergency evacuation can be hampered by weather, terrain, distance, equipment malfunction, and other factors, and are not a substitute for taking appropriate precautions and having adequate first-aid knowledge and equipment. Please call Northern Tier (218-365-4811) if you have any questions.

Florida Sea Base. Several activities are offered, including snorkeling, sailing, camping, kayaking, canoeing, swimming, fishing, and scuba diving. Diving is an exciting and demanding activity. When performed correctly, it is very safe. When established safety procedures are not followed, however, there are extreme dangers. All participants will need to learn from the instructor the important safety rules regarding breathing and equalization while scuba diving. Improper use of scuba equipment can result in serious injury, so participants must be instructed to use the equipment safely under direct supervision of a qualified instructor.

Advertencia de riesgo. Todas las bases de aventura extrema tienen excelentes antecedentes de salud y seguridad y se esfuerzan por minimizar los riesgos para los participantes y asesores haciendo hincapi en las precauciones de seguridad adecuadas. Ya que la mayora de los participantes estn preparados, tienen conciencia de los riesgos y toman precauciones de seguridad, no experimentan lesiones. Si usted decide acudir a Philmont, Northern Tier, Base Marina de la Florida O 3UMMIT "ECHTEL 2ESERVE USTED DEBER ESTAR EN FORMA FSICAtener indumentaria y equipo adecuado, y estar dispuesto a seguir instrucciones, trabajar en equipo con su grupo y hacerse responsable de su propia salud y seguridad.Los padres, tutores y participantes de cualquier programa de aventura extrema son notificados de que el recorrido hacia y desde dichas bases puede implicar exposicin a accidentes, enfermedades o lesiones.Los miembros del personal de aventura extrema han sido CAPACITADOS EN PRIMEROS AUXILIOS 2#0 Y PREVENCIN DE ACCIDENTESy estn preparados para ayudar al asesor adulto a reconocer, reaccionar y responder ante accidentes, lesiones y enfermedades segn sea necesario. Se requiere que cada grupo tenga por lo menos UN MIEMBRO CAPACITADO EN PRIMEROS AUXILIOS EN LA NATURALEZA Y 2#0Los servicios mdicos y de bsqueda y rescate son proporcionados como respuesta ante un accidente o emergencia. Sin embargo, los tiempos de respuesta pueden verse afectados por la ubicacin, el terreno, el tiempo, u otras emergencias y puede retrasarse por horas o incluso das en un entorno silvestre.

Philmont. Los participantes e invitados de las actividades Philmont que se realicen con acceso limitado a las zonas campestres, incluyendo la mayora de las conferencias y programas familiares en el Centro de Capacitacin Philmont, debern repasar la Parte D para entender los riesgos potenciales inherentes a los 6,700 pies de elevacin en un ambiente seco del Suroeste. La gran altitud; un programa de aventura extrema fsicamente exigente en reas montaosas remotas; acampar mientras se est expuesto a condiciones climatolgicas ocasionalmente severas tales como relmpagos, granizo, inundaciones repentinas, y calor; y otros problemas potenciales, incluyendo lesiones a causa de tropezones y cadas, cadas de un caballo, golpe de calor, y accidentes de vehculos a motor, pueden empeorar condiciones mdicas subyacentes. Los senderos de Philmont son empinados y pedregosos. Los animales salvajes tales como osos, vboras de cascabel y pumas son nativos de la zona y por lo general presentan poco peligro si se toman las precauciones adecuadas. Por favor, llame a Philmont (575-376-2281) si tiene preguntas.

Northern Tier. Mientras participe en las reas silvestres de acampada y canotaje de Northern Tier, debe llevar puesto el chaleco salvavidas en todo momento que se encuentre en el agua. Los miembros del grupo viajan juntos siempre. Las comunicaciones de emergencia va radio y en lugares ms remotos por telfono satelital, son proporcionadas por Northern Tier. La comunicacin por radio y la evacuacin de emergencia puede ser obstaculizada por el tiempo, el terreno, la distancia, mal funcionamiento del equipo y otros factores, y no substituyen el tomar las precauciones apropiadas y tener conocimiento y equipo adecuado de primeros auxilios. Por favor, llame a Northern Tier (218-365-4811) si tiene cualquier pregunta.

Base Marina de la Florida. Se ofrecen varias actividades incluyendo snorkel, vela, acampada, kayak, canotaje, natacin, pesca y buceo. El buceo es una actividad emocionante y exigente. Cuando se realiza de forma correcta, es muy segura. Sin embargo, cuando los procedimientos de seguridad establecidos no se siguen, existen peligros extremos. Todos los participantes necesitan aprender del instructor las reglas de seguridad importantes referentes a la respiracin y ecualizacin mientras se practica el buceo. El uso inadecuado del equipo de buceo puede resultar en lesiones graves, por lo tanto, se les debe instruir a los participantes a utilizar el equipo de manera segura bajo la supervisin directa de un instructor calificado.


To scuba dive safely, participants must not be extremely overweight or in poor physical condition. Diving can be strenuous under certain conditions. Participants respiratory and circulatory systems must be in good health. All body air spaces must be normal and healthy. A person with heart trouble, a current cold or congestion, epilepsy, asthma, or a severe medical problem, or who is under the influence of alcohol or drugs, should not dive. If taking medication, participants should consult a doctor and the instructor before participation in this program. If there is a question about the advisability of participation, contact the family physician first, then call the Sea Base at 305-664-5612. The Sea Base health supervisor reserves the right to make medical decisions regarding the participation of individual at Sea Base.

Food. Each base offers food appropriate for the experience. If a participant has a problem with the diet described in the participant guide, please contact the high-adventure base you are considering attending. Medications. Each participant who has a condition requiring medication should bring an appropriate supply for the duration of the trip. Consider bringing duplicate or even triplicate supplies of vital medications. People with allergies that have resulted in severe reactions or anaphylaxis must bring with them an EpiPen that has not expired. Immunizations. Each participant must have received a TETANUS IMMUNIZATION WITHIN THE LAST YEARS 2ECOGNITIONwill be given to the rights of those Scouts and Scouters who do not have immunizations because of philosophical, political, or religious beliefs. In such a situation, the Immunization Exemption Request form is required.Recommendations Regarding Chronic Illnesses. Each base requires that this information be shared with the parents or guardians and examining physician of every participant. There are no facilities for extended care or treatment; therefore participants who cannot meet these requirements will be sent home at their expense.

Staff and/or staff physicians reserve the right to deny the participation of any individual on the basis of a physical examination and/or medical history.

Adults or youth who have had any of the following conditions should undergo a thorough evaluation by a physician before considering participation at a BSA high-adventure base.

Cardiac or Cardiovascular Disease, including:

1. Angina (chest pain caused by blocked blood vessels or coming from the heart)

2. Myocardial infarction (heart attack)3. Heart surgery or heart catheterization, including

angioplasty (balloon dilation) or stents to treat blocked blood vessels

4. Stroke or transient ischemic attacks (TIAs)5. Claudication (leg pain with exercise, caused by hardening

of the arteries)6. Family history of heart disease or a family member who

died unexpectedly before age 507. Diabetes8. Smoking %XCESSIVE WEIGHT

Para bucear de manera segura, los participantes no deben estar extremadamente pasados de peso o tener condicin fsica deficiente. Bucear puede ser extenuante bajo ciertas condiciones. Los sistemas respiratorio y circulatorio de los participantes deben estar en buena condicin. Todos los espacios de aire del cuerpo deben ser normales y estar saludables. Una persona con problemas del corazn, un resfriado o congestionamiento, epilepsia, asma o un problema mdico severo, o que est bajo la influencia del alcohol o drogas, no debe bucear. Si se est tomando medicamentos, los participantes debern consultar a un doctor y al instructor antes de participar en este programa. Si hay alguna pregunta sobre la conveniencia de la participacin, contacte al mdico familiar primero, luego llame a la Base Marina al 305-664-5612. El supervisor de salud de la Base marina se reserva el derecho de tomar decisiones mdicas con respecto a la participacin de un individuo en la Base Marina.

Comida. Cada base ofrece comida apropiada para la experiencia. Si un participante tiene un problema con la dieta descrita en la gua, favor de comunicarse con la base de aventura extrema que est considerando visitar.Medicamentos. Cada participante que tenga una condicin que requiera medicamentos deber traer consigo la cantidad apropiada para la duracin del viaje. Considere traer suministros por duplicado o incluso triplicado de medicamentos vitales. Las personas con alergias que hayan resultado en reacciones severas o anafilaxia deben traer consigo una EpiPen que no haya caducado.Vacunas. Cada participante debe haber recibido una vacuna contra el ttanos en los ltimos 10 aos. Se les dar reconocimiento a los derechos de aquellos Scouts o Scouters que no tienen vacunas a causa de creencias filosficas, polticas o religiosas. En dicha situacin, se requiere el formulario Solicitud de exencin de inmunizacin.Recomendaciones con respecto a enfermedades crnicas. Cada base requiere que se le comunique esta informacin a los padres o tutores y mdico que realice el examen de cada participante. No hay instalaciones para atencin o tratamiento prolongado, por lo tanto, los participantes que no puedan cumplir con dichos requisitos sern enviados a casa y deben asumir los gastos.

El personal y los mdicos del personal se reservan el derecho de negarle la participacin a cualquier individuo con base en el examen fsico o historial mdico.

Los adultos o nios que hayan tenido cualquiera de las siguientes condiciones, debern someterse a una evaluacin por parte de un mdico antes de considerar participar en una base de aventura extrema BSA.

Enfermedad cardiaca o cardiovascular, incluyendo:

1. Angina (dolor de pecho causado por vasos sanguneos bloqueados o que vienen del corazn).

2. Infarto al miocardio (ataque al corazn). 3. Ciruga de corazn o cateterismo cardiaco, incluyendo

angioplastia (dilatacin con baln) o stents para tratar vasos sanguneos bloqueados.

4. Derrame cerebral o ataques isqumicos transitorios (AIT).5. Claudicacin (dolor de pierna con el ejercicio, causado por el

endurecimiento de las arterias). 6. Historial familiar de enfermedad cardiaca o que un miembro de

la familia haya muerto inesperadamente antes de los 50 aos de edad.

7. Diabetes.8. Tabaquismo. %XCESO DE PESO


Participants who have a congenital heart disease or an acquired heart disease such as rheumatic fever, Kawasakis disease, or mitral valve prolapse should undergo thorough evaluation by a physician before considering participating at a high-adenture base. The physical exertion at any of the high-adventure bases may precipitate either a heart attack or stroke in susceptible persons. Participants with a history of any of the first seven conditions listed above should have a physician-supervised stress test. More extensive testing (e.g., nuclear stress test) is recommended for participants who have coronary heart disease. Even if the stress test results are normal, the results of testing done at lower elevations, without backpacks, do not guarantee safety. If the test results are abnormal, the individual is advised not to participate.Hypertension (High Blood Pressure). The combination of physical, mental, and emotional stress, increased exertion and/or heat, and altitude appears to cause a significant increase in blood pressure in some individuals. Occasionally, hypertension reaches such a level that it is no longer safe to engage in strenuous activity. Hypertension can increase the risk of having a stroke, heart attack, or angina. Participants should have a blood pressure less than 140/90. Persons WITH SIGNIlCANT HYPERTENSION GREATER THAN SHOULDbe treated and controlled before attending any high-adventure base, and should continue on medications while participating. The goal of treatment should be to lower the blood pressure to normal levels. Participants already on antihypertensive therapy with normal blood pressure should continue on medications. Individuals taking diuretics to treat hypertension are at increased risk for dehydration related to strenuous physical activity and should be careful to maintain good hydration during the trek.

Philmont. Each participant who is 18 years of age or older will have his or her blood pressure checked at Philmont. Those individuals with a blood pressure consistently greater than 160/100 at Philmont may be kept off the trail until their blood pressure decreases.Florida Sea Base. Those taking beta-blocker medication should consider a change of medication before participating in any scuba program.

Insulin-Dependent Diabetes Mellitus. Exercise and the type of food eaten affect insulin requirements. Any individual with insulin-dependent diabetes mellitus should be able to monitor personal blood glucose and to know how to adjust insulin doses based on these factors. The person with diabetes also should know how to give a self-injection. Both the person with diabetes and one other person in the group should be able to recognize indications of excessively high blood sugar (hyperglycemia or diabetic ketoacidosis) and excessively low blood sugar (hypoglycemia). The person with diabetes and one other individual should know the appropriate initial responses for these conditions. An insulin-dependent person who has been newly diagnosed (within the last six months) or who has undergone a change in delivery system (e.g., insulin pump) in the last six months is advised not to participate. A person with diabetes who has had frequent hospitalizations for diabetic ketoacidosis or who has had frequent problems with hypoglycemia should not participate until better control of the diabetes has been achieved.

Los jvenes que tengan alguna enfermedad cardiaca congnita o enfermedad cardiaca adquirida como fiebre reumtica, enfermedad de Kawasaki o prolapso de la vlvula mitral debern someterse a un examen mdico exhaustivo antes de considerar participar en una base de aventura extrema. El esfuerzo fsico en cualquiera de las bases de aventura extrema puede precipitar ya sea un ataque al corazn o derrame cerebral en las personas susceptibles. Los participantes con antecedentes de cualquiera de las primeras siete condiciones enumeradas anteriormente debern someterse a una prueba de esfuerzo supervisada por un mdico. Se recomiendan pruebas ms exhaustivas (por ejemplo, prueba de esfuerzo con radioistopos) para los participantes que tengan una enfermedad coronaria. Incluso si los resultados de la prueba de esfuerzo son normales, los resultados de la prueba realizada en elevaciones bajas, sin mochilas, no garantiza la seguridad. Si los resultados de la prueba son anormales, se le aconseja al individuo no participar. Hipertensin (Presin arterial alta). La combinacin de estrs fsico, mental y emocional, el aumento de esfuerzo y de calor, y la altura, aparentemente causan un incremento significativo en la presin arterial en algunos individuos. En ocasiones, la hipertensin alcanza tal nivel que no es seguro participar en una actividad vigorosa. La hipertensin puede incrementar el riesgo de tener un derrame cerebral, ataque al corazn o angina. Los participantes deben tener una presin arterial normal menor de 140/90. Las personas con una hipertensin importante (mayor a DEBERN ESTAR BAJO TRATAMIENTO Y SU CONDICIN DEBE ESTARcontrolada antes de que acudan a cualquier base de aventura extrema, y debern continuar con sus medicamentos mientras participen. El objetivo del tratamiento debe ser disminuir la presin arterial a niveles normales. Aquellos que ya se encuentren bajo tratamiento antihipertensivo y que tengan una presin arterial normal debern continuar con su tratamiento. Los individuos que tomen diurticos para tratar la hipertensin corren un mayor riesgo de deshidratacin relacionada con actividad fsica desgastante y debern tener cuidado de mantener una muy buena hidratacin durante la excursin.

Philmont. A cada participante que tenga 18 aos de edad o ms se le tomar la presin en Philmont. Aquellos individuos con presin arterial consistentemente mayor a 160/100 en Philmont sern apartados del sendero hasta que la presin arterial disminuya.Base Marina de la Florida. Quienes toman medicamentos beta bloqueadores deberan considerar cambiar de medicamento antes de participar en cualquier programa de buceo.

Diabetes Mellitus dependiente de insulina. El ejercicio y el tipo de alimentos que se consumen afectan la necesidad de insulina. Cualquier persona que padezca diabetes mellitus dependiente de insulina deber ser capaz de autocontrolar su nivel de glucosa en la sangre y saber cmo ajustar las dosis de insulina con base en estos factores. Las personas con diabetes tambin deben saber cmo inyectarse. Tanto la persona con diabetes y otra ms en el grupo debe saber reconocer los sntomas de niveles excesivamente altos de azcar (hiperglucemia o cetoacidosis diabtica) y los de niveles excesivamente bajos de azcar en la sangre (hipoglicemia). La persona con diabetes y otra persona ms debern saber las respuestas iniciales apropiadas para dichas condiciones. Una persona dependiente de insulina que haya sido diagnosticada recientemente (en los ltimos 6 meses) o que se haya sometido a un cambio en el sistema de dosificacin (por ejemplo, una bomba para insulina) en el mismo periodo no deber intentar participar. Una persona que haya sido hospitalizada frecuentemente debido a cetoacidosis diabtica o que haya tenido problemas frecuentes de hipoglicemia, no deber participar hasta que se obtenga un mejor control de la diabetes.


Philmont. It is recommended that the person with diabetes and one other individual carry insulin on the trek (in case of accident) and that a third vial be kept at the Health Lodge for backup. Bring insulin in a small insulated container. Bring enough testing equipment and supplies for the entire trip and trek. Extras are usually needed. If an individual has been hospitalized for diabetes-

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Wapashuwi Lodge 56 WTGC Guide