ventura county council boy scouts of america

��'03.4�"/%�10-*$*&4

Ventura County Council Boy Scouts of America

Ventura County Council ● A Century of Service

Dear Unit Leader:

Camp Three Falls management and staff looks forward to having you join us at Camp this summer.

To help us better prepare for your stay, and to ensure that everyone is as safe and healthy as possible, we need each unit (Scouts BSA Troop or Webelos Den) to fill out a few documents. It may take a few minutes (okay, maybe more than a few minutes) to compile the information – but better to do it now, than to arrive without necessary documents and extend your check-in process.

The attachment to this email includes documents for both Webelos and Scouts BSA.

UNIT PRECAMP PACKET

Drop off or mail the following forms to the Ventura County Council office, 509 E. Daily Drive, Camarillo, CA 93010, at least two weeks before your arrival at camp. One packet per unit; do not have parents drop off individual forms, since they may be misplaced. Provide copies of your medical forms, not the originals. We will review the forms and contact you if there is anything missing.

Unit Roster Form: Fill out with the requested information for all adults and youth attending camp. Note that all adults must complete BSA Youth Protection Training (YPT) before coming to camp. Provide copies of YPT cards or training records showing completing of YPT within two years.

BSA Health and Medical Record, 2019 revision: This form must be filled out completely for every adult and youth who will be staying in camp, even for one night. That includes parts A, B1, B2, and C. We have included a blank form, as well as a form with frequently overlooked items highlighted. Give us a copy, not the original. And don’t forget to attach a copy of the front and back of each camper’s medical insurance card.

California Firearms Permission Slip: Required for all youth participants to use BB guns, 22 rifles or other firearms at camp.

COVID 19 Waiver Form: Required of all participants

Special Needs Form: A separate form for each individual in the group who has special dietary, mobility, or other needs. You may send these in earlier if you wish, but also include a copy with the Pre-Camp Packet

BRING TO CAMP WITH YOU: Your copy of your Unit Roster and each person’s BSA Health and Medical Record.

COVID 19 Screening Form. Fill out for each participant immediately before leaving for camp. Our health staff will ask to see each person’s form on arrival at camp.

Merit Badge Prerequisite Form (Scouts BSA only): Some merit badges have requirements that cannot be completed at camp, and we need the unit leader to verify completion – an example is the nights camping requirement for Camping Merit Badge. Fill out a separate form for each scout, for each merit badge that has a prerequisite. Scouts should bring the form to the merit badge class on the first day of classes.

If you have any questions, please do not hesitate to contact us as your questions arise. We cannot wait to see you this summer!

Jerry Thurston Camp Director Camp Three Falls Larry Tuck Program Director Camp Three Falls

George Villalobos Scout Executive Ventura County Council

Parents’ Fact Sheet Troop # _____________ is attending Camp Three Falls from _______________ to ________________.

We will depart from _____________________________ on ____________ at ____________.

We will return on ______________ at around _________________.

Lunch is not provided on the day that we arrive in camp, so please pack a sack lunch. Make sure that the Scout has everything. Double check that Scouts have their prescription medicines (give to Scout-master in Ziploc bag along with Scout’s name and instructions). Check to be certain that the permission and medical forms are complete, including all necessary signatures and dates from physicians and par-ents.

The cost for each Scout to attend camp is $_________. This includes almost everything. You’ll want to provide some extra money for trading post items, souvenirs, snacks, and to pay for some advancement supplies such as handicraft kits and shooting supplies. If you ask, your unit leader may be willing to su-pervise this money.

MAIL TO CAMP

It is recommended that letters to Scouts at camp be mailed early (even before camp), as mail service to camp can be slow. The address is:

Scout’s Name) ——————————— Troop #__________ Week __________ Camp Three Falls 12260 Boy Scout Camp Road Frazier Park, CA 93225

EMERGENCY PHONE NUMBERS: Emergencies at home may be reported to the Council Service Center at (805) 482-8938 (during busi-ness hours), or call Camp Three Falls directly at (661) 245-1206. The camp office will not be open until June 18. Contact your unit leader with questions, or call the council office. Call me, _________________________ at _____________________ if you have any unanswered questions.

THERE ARE NO PHONES IN CAMP FOR SCOUT USE. IN AN EMERGENCY, CAMP STAFF OR YOUR UNIT LEADER WILL CONTACT YOU.

&$03�7+5((�)$//6

81,7�5267(5

8QLW�1XPEHU�BBBBBBBBBBBBBB�&RXQFLO�BBBBBBBBBBBBBBBBBBBBB�'LVWULFW�BBBBBBBBBBBBBBBBBBBBBBBB

:HEHORV�6HVVLRQ��-XQH��-��BBBB��:HEHORV�6HVVLRQ��-XQH��--XO\��BBBB

6FRXWV�6HVVLRQ��-XO\��-��BBBB��6FRXWV�6HVVLRQ��-XO\��-��BBBB��6FRXWV�6HVVLRQ��-XO\��-��BBBB�

1XPEHU�DWWHQGLQJ��$GXOW�0DOH��BBBB�$GXOW�)HPDOH��BBBB�<RXWK�0DOH��BBBB�<RXWK�)HPDOH��BBBB

7ZR�'HHS�/HDGHUVKLS

8QLW�/HDGHU��BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB�� $VVLVWDQW�8QLW�/HDGHU��BBBBBBBBBBBBBBBBBBBBBBBBBBBBB

(PDLO��BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB (PDLO��BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB

&HOO�3KRQH��BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB &HOO�3KRQH��BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB

<37�7UDLQHG��BBB�<HV��BBB�1R 73�7UDLQHG"�BBB<HV�BBB�1R

+DYH�FRSLHV�RI�<37�&DUGV�RU�RWKHU�HYLGHQFH�RI�WUDLQLQJ�IRU�DOO�DGXOWV�DYDLODEOH�DW�FKHFN-LQ

$GGLWLRQDO�$GXOWV

0DOH )HPDOH <37�7UDLQHG"

$GXOW�BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB�� Ƒ Ƒ Ƒ $GXOW�BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB�� Ƒ Ƒ Ƒ $GXOW�BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB�� Ƒ Ƒ Ƒ $GXOW�BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB�� Ƒ Ƒ Ƒ $GXOW�BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB�� Ƒ Ƒ Ƒ $GXOW�BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB�� Ƒ Ƒ Ƒ $GXOW�BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB�� Ƒ Ƒ Ƒ $GXOW�BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB�� Ƒ Ƒ Ƒ $GXOW�BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB�� Ƒ Ƒ Ƒ

)25�$'

0,1,675

$7,9(�86(�

&DP

SVLWH�$VVLJHQHG��BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB

��7HQWV�BBBBBBBBBBBBBBBBBBBBBB�*XLGH��BBBBBBBBBBBBBBBBBBBBBBBBBBB

&$03�7+5((�)$//6

81,7�5267(5

8QLW�1XPEHU�BBBBBBBBBBBBBB�&RXQFLO�BBBBBBBBBBBBBBBBBBBBB�'LVWULFW�BBBBBBBBBBBBBBBBBBBBBBBB

:HEHORV�6HVVLRQ��-XQH��-��BBBB��:HEHORV�6HVVLRQ��-XQH��--XO\��BBBB

6FRXWV�6HVVLRQ��-XO\��-��BBBB��6FRXWV�6HVVLRQ��-XO\��-��BBBB��6FRXWV�6HVVLRQ��-XO\��-��BBBB�

6HQLRU�3DWURO�/HDGHU�RU�$FWLQJ�63/��6FRXWV�%6$�8QLWV�

1DPH��BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB�$JH��BBBBBBBBBBBBBBBBBB

3DWURO�'HQ�1DPH��BBBBBBBBBBBBBBBBBBBBBB��3DWURO�/HDGHU�'HQQHUBBBBBBBBBBBBBBBBBBBBBBBB�$JH��BB�0�)�BBB

1DPH�BBBBBBBBBBBBBBBBBBBBBBBBBB�$JH��BB�0�)�BBB��1DPH�BBBBBBBBBBBBBBBBBBBBBBBBBB�$JH��BB�0�)�BBB



















Part A: Informed Consent, Release Agreement, and Authorization

Full name: ___________________________________________

Date of birth: _________________________________________

AHigh-adventure base participants:Expedition/crew No.: _______________________________________________

or staff position: ___________________________________________________

680-001 2019 Printing

Adults NOT Authorized to Take Youth to and From Events:

Informed Consent, Release Agreement, and Authorization

I understand that participation in Scouting activities involves the risk of personal injury, including death, due to the physical, mental, and emotional challenges in the activities offered. Information about those activities may be obtained from the venue, activity coordinators, or your local council. I also understand that participation in these activities is entirely voluntary and requires participants to follow instructions and abide by all applicable rules and the standards of conduct.

In case of an emergency involving me or my child, I understand that efforts will be made to contact the individual listed as the emergency contact person by the medical provider and/or adult leader. 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/Con!dential Health Information (PHI/CHI) under the Standards for Privacy of Individually Identi!able Health Information, 45 C.F.R. §§160.103, 164.501, etc. seq., as amended from time to time, includes examination !ndings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities.

(If applicable) I have carefully considered the risk involved and hereby give my informed consent for my child to participate in all activities offered in the program. I further authorize the sharing of the information on this form with any BSA volunteers or professionals who need to know of medical conditions that may require special consideration in conducting Scouting activities.

With appreciation of the dangers and risks associated with programs and activities, on my own behalf and/or on behalf of my child, I hereby fully and completely release and waive any and all claims for personal injury, death, or loss that may arise against the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with any program or activity.

I also hereby assign and grant to the local council and the Boy Scouts of America, as well as their authorized representatives, the right and permission to use and publish the photographs/!lm/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 further authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said photographs/!lm/videotapes/electronic representations and/or sound recordings without limitation at the discretion of the BSA, and I speci!cally waive any right to any compensation I may have for any of the foregoing.

Every person who furnishes any BB device to any minor, without the express or implied permission of the parent or legal guardian of the minor, is guilty of a misdemeanor. (California Penal Code Section 19915[a]) My signature below on this form indicates my permission.

I give permission for my child to use a BB device. (Note: Not all events will include BB devices.)

� Checking this box indicates you DO NOT want your child to use a BB device.

List participant restrictions, if any: � None

________________________________________________________

Complete this section for youth participants only:Adults Authorized to Take Youth to and From Events:

You must designate at least one adult. Please include a phone number.

Name: _________________________________________________________________

Phone: _________________________________________________________________

Name: _________________________________________________________________

Phone: _________________________________________________________________

Name: _________________________________________________________________

Phone: _________________________________________________________________

Name: _________________________________________________________________

Phone: _________________________________________________________________

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 Scout Ranch, Philmont Training Center, Northern Tier, Sea Base, or the Summit Bechtel Reserve, I have also read and understand the supplemental risk advisories, 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 speci!cally noted by me or the health-care provider. If the participant is under the age of 18, a parent or guardian’s signature is required.

Participant’s signature: ____________________________________________________________________________________________ Date: ______________________________

Parent/guardian signature for youth: __________________________________________________________________________________ Date: ______________________________ (If participant is under the age of 18)

NOTE: Due to the nature of programs and activities, the Boy Scouts of America and local councils cannot continually monitor compliance of program participants or any limitations imposed upon them by parents or medical providers. However, so that leaders can be as familiar as possible with any limitations, list any restrictions imposed on a child participant in connection with programs or activities below.

Part B1: General Information/Health History

Full name: ___________________________________________

Date of birth: _________________________________________

B1High-adventure base participants:Expedition/crew No.: _______________________________________________


In case of emergency, notify the person below:

Name: ______________________________________________________________________________Relationship: ___________________________________________________

Address: _________________________________________________________________ Home phone: _________________________ Other phone: _________________________

Alternate contact name: _________________________________________________________________ Alternate’s phone: ______________________________________________

Age: ____________________________ Gender: __________________________ Height (inches): ___________________________ Weight (lbs.): ____________________________

Address: _________________________________________________________________________________________________________________________________________

City: ___________________________________________State: ____________________________ ZIP code: __________________ Phone: ______________________________

Unit leader: ____________________________________________________________________________ Unit leader’s mobile #: _________________________________________

Council Name/No.: _______________________________________________________________________________________________________Unit No.: ____________________

Health/Accident Insurance Company: ________________________________________________________ Policy No.: ___________________________________________________

Health HistoryDo you currently have or have you ever been treated for any of the following?

Yes No Condition Explain

Diabetes Last HbA1c percentage and date: Insulin pump: Yes � No �

Hypertension (high blood pressure)

Adult or congenital heart disease/heart attack/chest pain (angina)/heart murmur/coronary artery disease. Any heart surgery or procedure. Explain all “yes” answers.

Family history of heart disease or any sudden heart-related death of a family member before age 50.

Stroke/TIA

Asthma/reactive airway disease Last attack date:

Lung/respiratory disease

COPD

Ear/eyes/nose/sinus problems

Muscular/skeletal condition/muscle or bone issues

Head injury/concussion/TBI

Altitude sickness

Psychiatric/psychological or emotional dif!culties

Neurological/behavioral disorders

Blood disorders/sickle cell disease

Fainting spells and dizziness

Kidney disease

Seizures or epilepsy Last seizure date:

Abdominal/stomach/digestive problems

Thyroid disease

Skin issues

Obstructive sleep apnea/sleep disorders CPAP: Yes � No �

List all surgeries and hospitalizations Last surgery date:

List any other medical conditions not covered above

680-001 2019 Printing

Please attach a photocopy of both sides of the insurance card. If you do not have medical insurance, enter “none” above.


Full name: ___________________________________________

Date of birth: _________________________________________



� YES �NO Non-prescription medication administration is authorized with these exceptions: ________________________________________________________________

Administration of the above medications is approved for youth by:

_______________________________________________________________________ / _______________________________________________________________________

Parent/guardian signature MD/DO, NP, or PA signature (if your state requires signature)

Please list any additional information about your medical history:

_________________________________________

_________________________________________

_________________________________________

_________________________________________

DO NOT WRITE IN THIS BOX. Review for camp or special activity.

Reviewed by: ___________________________________________

Date: _________________________________________________

Further approval required: � Yes � No

Reason: _______________________________________________

Approved by: ____________________________________________

Date: _________________________________________________

DO YOU USE AN EPINEPHRINE � YES � NO AUTOINJECTOR? Exp. date (if yes) ___________________________

DO YOU USE AN ASTHMA RESCUE � YES � NO INHALER? Exp. date (if yes) ___________________________________

Allergies/Medications

Immunization

Are you allergic to or do you have any adverse reaction to any of the following?

Yes No Allergies or Reactions Explain Yes No Allergies or Reactions Explain

Medication Plants

Food Insect bites/stings

List all medications currently used, including any over-the-counter medications.

� Check here if no medications are routinely taken. � If additional space is needed, please list on a separate sheet and attach.

Medication Dose Frequency Reason

The following immunizations are recommended. Tetanus immunization is required and must have been received within the last 10 years. If you had the disease, check the disease column and list the date. If immunized, check yes and provide the year received.

Yes No Had Disease Immunization Date(s)

Tetanus

Pertussis

Diphtheria

Measles/mumps/rubella

Polio

Chicken Pox

Hepatitis A

Hepatitis B

Meningitis

In!uenza

Other (i.e., HIB)

Exemption to immunizations (form required)

680-001 2019 Printing

Bring enough medications in suf!cient 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.

Part C: Pre-Participation Physical This part must be completed by certi!ed and licensed physicians (MD, DO), nurse practitioners, or physician assistants.

Full name: ___________________________________________

Date of birth: _________________________________________

CHigh-adventure base participants:Expedition/crew No.: _______________________________________________


Please !ll in the following information:

Yes No Explain

Medical restrictions to participate

Height/Weight RestrictionsIf you exceed the maximum weight for height as explained in the following chart and your planned high-adventure activity will take you more than 30 minutes away from an emergency vehicle/accessible roadway, you may not be allowed to participate.

Maximum weight for height:

Height (inches) Max. Weight Height (inches) Max. Weight Height (inches) Max. Weight Height (inches) Max. Weight

60 166 65 195 70 226 75 260

61 172 66 201 71 233 76 267

62 178 67 207 72 239 77 274

63 183 68 214 73 246 78 281

64 189 69 220 74 252 79 and over 295

Examiner’s Certi!cationI certify that I have reviewed the health history and examined this person and !nd no contraindications for participation in a Scouting experience. This participant (with noted restrictions):

True False Explain

Meets height/weight requirements.

Has no uncontrolled heart disease, lung disease, or hypertension.

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.

Has no uncontrolled psychiatric disorders.

Has had no seizures in the last year.

Does not have poorly controlled diabetes.

If planning to scuba dive, does not have diabetes, asthma, or seizures.

Examiner’s signature: _______________________________________ Date: _______________

Examiner’s printed name: _________________________________________________________

Address: _______________________________________________________________________

City: ______________________________________State: ______________ ZIP code: _________

Of!ce phone: ___________________________________________________

Normal Abnormal Explain Abnormalities

Eyes

Ears/nose/throat

Lungs

Heart

Abdomen

Genitalia/hernia

Musculoskeletal

Neurological

Skin issues

Other


Medication Plants


680-001 2019 Printing

Height (inches) Weight (lbs.) BMI Blood Pressure Pulse

/

You are being asked to certify that this individual has no contraindication for participation in a Scouting experience. For individuals who will be attending a high-adventure program, including one of the national high-adventure bases, please refer to the supplemental information on the following pages or the form provided by your patient. You can also visit www.scouting.org/health-and-safety/ahmr to view this information online.

Part A: Informed Consent, Release Agreement, and Authorization

Full name: ___________________________________________

Date of birth: _________________________________________

AHigh-adventure base participants:Expedition/crew No.: _______________________________________________


680-0012019 Printing

Adults NOT Authorized to Take Youth to and From Events:

Informed Consent, Release Agreement, and Authorization

I understand that participation in Scouting activities involves the risk of personal injury, including death, due to the physical, mental, and emotional challenges in the activities offered. Information about those activities may be obtained from the venue, activity coordinators, or your local council. I also understand that participation in these activities is entirely voluntary and requires participants to follow instructions and abide by all applicable rules and the standards of conduct.

In case of an emergency involving me or my child, I understand that efforts will be made to contact the individual listed as the emergency contact person by the medical provider and/or adult leader. 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/Con!dential Health Information (PHI/CHI) under the Standards for Privacy of Individually Identi!able Health Information, 45 C.F.R. §§160.103, 164.501, etc. seq., as amended from time to time, includes examination !ndings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities.

(If applicable) I have carefully considered the risk involved and hereby give my informed consent for my child to participate in all activities offered in the program. I further authorize the sharing of the information on this form with any BSA volunteers or professionals who need to know of medical conditions that may require special consideration in conducting Scouting activities.

With appreciation of the dangers and risks associated with programs and activities, on my own behalf and/or on behalf of my child, I hereby fully and completely release and waive any and all claims for personal injury, death, or loss that may arise against the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with any program or activity.

I also hereby assign and grant to the local council and the Boy Scouts of America, as well as their authorized representatives, the right and permission to use and publish the photographs/!lm/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 further authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said photographs/!lm/videotapes/electronic representations and/or sound recordings without limitation at the discretion of the BSA, and I speci!cally waive any right to any compensation I may have for any of the foregoing.

Every person who furnishes any BB device to any minor, without the express or implied permission of the parent or legal guardian of the minor, is guilty of a misdemeanor. (California Penal Code Section 19915[a]) My signature below on this form indicates my permission.

I give permission for my child to use a BB device. (Note: Not all events will include BB devices.)

� Checking this box indicates you DO NOT want your child to use a BB device.

List participant restrictions, if any: � None

________________________________________________________

Complete this section for youth participants only:Adults Authorized to Take Youth to and From Events:

You must designate at least one adult. Please include a phone number.

Name: _________________________________________________________________

Phone: _________________________________________________________________

Name: _________________________________________________________________

Phone: _________________________________________________________________

Name: _________________________________________________________________

Phone: _________________________________________________________________

Name: _________________________________________________________________

Phone: _________________________________________________________________

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 Scout Ranch, Philmont Training Center, Northern Tier, Sea Base, or the Summit Bechtel Reserve, I have also read and understand the supplemental risk advisories, 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 speci!cally noted by me or the health-care provider. If the participant is under the age of 18, a parent or guardian’s signature is required.

Participant’s signature: ____________________________________________________________________________________________ Date: ______________________________

Parent/guardian signature for youth: __________________________________________________________________________________ Date: ______________________________(If participant is under the age of 18)

NOTE: Due to the nature of programs and activities, the Boy Scouts of America and local councils cannot continually monitor compliance of program participants or any limitations imposed upon them by parents or medical providers. However, so that leaders can be as familiar as possible with any limitations, list any restrictions imposed on a child participant in connection with programs or activities below.

DO NOT U

SE THIS FORM

FOR INSTRUCTIO

NAL PURPOSES O

NLY

ehess

Rectangle

ehess

Highlight

ehess

Rectangle

ehess

Rectangle


Full name: ___________________________________________

Date of birth: _________________________________________



In case of emergency, notify the person below:

Name: ______________________________________________________________________________Relationship: ___________________________________________________

Address: _________________________________________________________________ Home phone: _________________________ Other phone: _________________________

Alternate contact name: _________________________________________________________________ Alternate’s phone: ______________________________________________

Age: ____________________________ Gender: __________________________ Height (inches): ___________________________ Weight (lbs.): ____________________________

Address: _________________________________________________________________________________________________________________________________________

City: ___________________________________________State: ____________________________ ZIP code: __________________ Phone: ______________________________

Unit leader: ____________________________________________________________________________ Unit leader’s mobile #: _________________________________________

Council Name/No.: _______________________________________________________________________________________________________Unit No.: ____________________

Health/Accident Insurance Company: ________________________________________________________ Policy No.: ___________________________________________________

Health HistoryDo you currently have or have you ever been treated for any of the following?

Yes No Condition Explain

Diabetes Last HbA1c percentage and date: Insulin pump: Yes � No �

Hypertension (high blood pressure)

Adult or congenital heart disease/heart attack/chest pain (angina)/heart murmur/coronary artery disease. Any heart surgery or procedure. Explain all “yes” answers.

Family history of heart disease or any sudden heart-related death of a family member before age 50.

Stroke/TIA

Asthma/reactive airway disease Last attack date:

Lung/respiratory disease

COPD

Ear/eyes/nose/sinus problems

Muscular/skeletal condition/muscle or bone issues

Head injury/concussion/TBI

Altitude sickness

Psychiatric/psychological or emotional dif!culties

Neurological/behavioral disorders

Blood disorders/sickle cell disease

Fainting spells and dizziness

Kidney disease

Seizures or epilepsy Last seizure date:

Abdominal/stomach/digestive problems

Thyroid disease

Skin issues

Obstructive sleep apnea/sleep disorders CPAP: Yes � No �

List all surgeries and hospitalizations Last surgery date:

List any other medical conditions not covered above

680-001 2019 Printing

Please attach a photocopy of both sides of the insurance card. If you do not have medical insurance, enter “none” above.

DO NOT U

SE THIS FORM

FOR INSTRUCTIO

NAL PURPOSES O

NLY

ehess

Rectangle

ehess

Rectangle


Full name: ___________________________________________

Date of birth: _________________________________________



� YES �NO Non-prescription medication administration is authorized with these exceptions: ________________________________________________________________

Administration of the above medications is approved for youth by:

_______________________________________________________________________ / _______________________________________________________________________Parent/guardian signature MD/DO, NP, or PA signature (if your state requires signature)

Please list any additional information about your medical history:

_________________________________________

_________________________________________

_________________________________________

_________________________________________

DO NOT WRITE IN THIS BOX. Review for camp or special activity.

Reviewed by: ___________________________________________

Date: _________________________________________________

Further approval required: � Yes � No

Reason: _______________________________________________

Approved by: ____________________________________________

Date: _________________________________________________

DO YOU USE AN EPINEPHRINE � YES � NO AUTOINJECTOR? Exp. date (if yes) ___________________________

DO YOU USE AN ASTHMA RESCUE � YES � NO INHALER? Exp. date (if yes) ___________________________________

Allergies/Medications

Immunization

Are you allergic to or do you have any adverse reaction to any of the following?


Medication Plants


List all medications currently used, including any over-the-counter medications.

� Check here if no medications are routinely taken. � If additional space is needed, please list on a separate sheet and attach.

Medication Dose Frequency Reason

The following immunizations are recommended. Tetanus immunization is required and must have been received within the last 10 years. If you had the disease, check the disease column and list the date. If immunized, check yes and provide the year received.

Yes No Had Disease Immunization Date(s)

Tetanus

Pertussis

Diphtheria

Measles/mumps/rubella

Polio

Chicken Pox

Hepatitis A

Hepatitis B

Meningitis

In!uenza

Other (i.e., HIB)

Exemption to immunizations (form required)

680-0012019 Printing

Bring enough medications in suf!cient 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.

DO NOT U

SE THIS FORM

FOR INSTRUCTIO

NAL PURPOSES O

NLY

ehess

Rectangle

ehess

Rectangle

ehess

Rectangle

ehess

Rectangle

ehess

Rectangle

ehess

Rectangle

ehess

Rectangle

Part C: Pre-Participation Physical This part must be completed by certi!ed and licensed physicians (MD, DO), nurse practitioners, or physician assistants.

Full name: ___________________________________________

Date of birth: _________________________________________

CHigh-adventure base participants:Expedition/crew No.: _______________________________________________


Please !ll in the following information:

Yes No Explain

Medical restrictions to participate

Height/Weight RestrictionsIf you exceed the maximum weight for height as explained in the following chart and your planned high-adventure activity will take you more than 30 minutes away from an emergency vehicle/accessible roadway, you may not be allowed to participate.

Maximum weight for height:

Height (inches) Max. Weight Height (inches) Max. Weight Height (inches) Max. Weight Height (inches) Max. Weight

60 166 65 195 70 226 75 260

61 172 66 201 71 233 76 267

62 178 67 207 72 239 77 274

63 183 68 214 73 246 78 281

64 189 69 220 74 252 79 and over 295

Examiner’s Certi!cationI certify that I have reviewed the health history and examined this person and !nd no contraindications for participation in a Scouting experience. This participant (with noted restrictions):

True False Explain

Meets height/weight requirements.

Has no uncontrolled heart disease, lung disease, or hypertension.

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.

Has no uncontrolled psychiatric disorders.

Has had no seizures in the last year.

Does not have poorly controlled diabetes.

If planning to scuba dive, does not have diabetes, asthma, or seizures.

Examiner’s signature: _______________________________________ Date: _______________

Examiner’s printed name: _________________________________________________________

Address: _______________________________________________________________________

City: ______________________________________State: ______________ ZIP code: _________

Of!ce phone: ___________________________________________________

Normal Abnormal Explain Abnormalities

Eyes

Ears/nose/throat

Lungs

Heart

Abdomen

Genitalia/hernia

Musculoskeletal

Neurological

Skin issues

Other


Medication Plants


680-001 2019 Printing

Height (inches) Weight (lbs.) BMI Blood Pressure Pulse

/

You are being asked to certify that this individual has no contraindication for participation in a Scouting experience. For individuals who will be attending a high-adventure program, including one of the national high-adventure bases, please refer to the supplemental information on the following pages or the form provided by your patient. You can also visit www.scouting.org/health-and-safety/ahmr to view this information online.

DO NOT U

SE THIS FORM

FOR INSTRUCTIO

NAL PURPOSES O

NLY

ehess

Rectangle

ehess

Rectangle

CALIFORNIA SHOOTING SPORTS PARENTAL/LEGAL GUARDIAN PERMISSION FORM

I, , parent or legal guardian of , (Print Name of Parent or Legal Guardian) (Print Name of Child)

hereby give my child express permission and consent to be loaned and possess firearms (handguns

and long guns) and ammunition to engage in lawful, recreational sport, including target practice,

and/or a course of instruction in the safe and lawful use of a handgun. (Cal. Penal Code §§ 27945,

29610, 29615, 29650, 29655; 18 U.S.C § 922(x)). As used in this form, “firearms” include any

handguns, long guns, or shotguns that may lawfully loaned to and possessed by a minor under state

and federal law.

I also give my child express permission and consent to possess, and for a person to loan to my child, a

“BB device” as defined in Cal. Penal Code * 16250. (Cal. Penal Code § 19915).

This consent is valid, absent my express revocation thereof, for the calendar year of . (Calendar Year)

A photocopy or facsimile of this written consent will serve as an original. I represent that I am (1) the parent or legal guardian of the minor named above and (2) not prohibited

by Federal, state, or local law from possessing a firearm. I agree to indemnify and hold harmless the

Boy Scouts of America, and any local Council and all officers, members, employees, and volunteers

thereof, from all losses, damages, causes of action, cost and expenses, arising from any false

statements or representations made by me herein. The undersigned also grants permission for participation in a Camp Archery Program and Camp Slingshot Program, with use of archery equipment and slingshot equipment.

Signature of Parent or Legal Guardian Date

Without this waiver, the camper will not be able to participate in the shooting sports program and he will be given an alternate activity. A signed copy of this form must be on file with the Camp Director.

Unit #:

Last Nam

e:

First Nam

e:

COVID-19 WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT

In consideration for receiving permission to BE ON PREMISES at VENTURA COUNTY COUNCIL

CAMP THREE FALLS (hereinafter the “Activity or Activities”), I, on behalf of myself and any minor

child/children for whom I have the capacity to contract, hereby acknowledge and agree to the following:

1. I understand the hazards of the novel coronavirus (“COVID-19”) and am familiar with the Centers

for Disease Control and Prevention (“CDC”) guidelines regarding COVID-19. I acknowledge and

understand that that the circumstances regarding COVID-19 are changing from day to day and

that, accordingly, the CDC guidelines are regularly modified and updated and I accept full

responsibility for familiarizing myself with the most recent updates of the CDC and the policies

and procedures set forth by Ventura County Council pertaining to participation in the Activity.

2. Notwithstanding the risks associated with COVID-19, which I readily acknowledge, I hereby

willingly choose to participate in Activities.

3. I acknowledge and fully assume the risk of illness or death related to COVID-19 and other causes

arising from my being on the premises and participating in the Activities and hereby RELEASE,

WAIVE, DISCHARGE, AND COVENANT NOT TO SUE (on behalf of myself and any minor

children form whom I have the capacity contract) VENTURA COUNTY COUNCIL, CAMP

THREE FALLS, SCOUTING BSA their owners, officers, directors, volunteers, agents, employees

and assigns (the “RELEASEES”) from any liability related to COVID-19 which might occur as a

result my being on the premises and participating in the Activities.

4. I shall indemnify, defend and hold harmless the RELEASEES from and against any and all

claims, demands, suits, judgments, losses or expenses of any nature whatsoever (including,

without limitation, attorneys’ fees, costs and disbursements, whether of in-house or outside

counsel and whether or not an action is brought, on appeal or otherwise), arising from or out of, or

relating to, directly or indirectly, the infection of COVID-19 or any other illness or injury.

5. I understand that I have an obligation to inform Ventura County Council about any illnesses

(including transmittable diseases) as they occur during any periods in which I and those on whose

behalf I contract are contagious, and in the two weeks following our participation in the Activity.

IN SIGNING THIS AGREEMENT, I ACKNOWLEDGE AND REPRESENT THAT I have read

the foregoing Wavier of Liability and Hold Harmless Agreement, understand it and sign it

voluntarily as my own free act and deed; no oral representations, statements, or inducements,

apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of

age and fully competent; and I execute this Agreement for full, adequate and complete

consideration fully intending to be bound by same.

IN WITNESS WHEREOF, I have signed this Waiver and Agreement on this

day of , 2021.

SIGNATURE:

NAME:

NAMES OF MINOR CHILD(REN):

COVID-19 Pre-Event Medical Screening Checklistq Yes q No Have you or has anyone in your household been in close contact* in the past 14 days with

anyone known or suspected to have COVID-19 or is otherwise sick?

q Yes q No Have you or has anyone in your household been in close contact* with anyone who has been tested for COVID-19 and is waiting for results?

q Yes q No Have you or has anyone in your household been sick in the past 14 days, or have you or they been tested for any illness and are waiting for results?

q Yes q No Has anyone in your household been exposed to an individual known or suspected to have COVID-19 in the past 14 days?

q Yes q No Have you or has anyone you have been in close contact* with traveled on a cruise ship or internationally or to an area with a known communicable disease outbreak in the past 14 days?

*According to the Centers for Disease Control and Prevention (CDC), “close contact” means:• You were within 6 feet of someone who has COVID-19 for a cumulative total of

15 minutes or more over a 24-hour period• You had direct physical contact with an infected person (hugged or kissed them)• You shared eating or drinking utensils• An infected person sneezed, coughed, or otherwise got respiratory droplets on you

If the answer is YES to any one of the five questions above, the participant must stay home.

If all answers above are NO, proceed to the symptoms list below.

�� /2� Revision

Symptoms of COVID-19If anyone in your household has any one of the following new or worsening signs

or symptoms of possible COVID-19, the entire household must stay home.

qq Shortness of breathShortness of breathqq Cough Coughqq Fever of 100.0º or greaterFever of 100.0º or greaterqq Flu-like symptomsFlu-like symptomsqq Repeated shaking with chillsRepeated shaking with chillsqq Fatigue Fatigueqq Muscle or body achesMuscle or body achesqq Headache Headacheqq Sore throatSore throatqq Loss of taste or smellLoss of taste or smellqq Diarrhea Diarrheaqq Nausea or vomitingNausea or vomiting

*Potential Higher-Risk Individuals*q Yes q No Are you in a higher-risk category as defined by the CDC guidelines, including older adults,

people with medical conditions, and those with other individual circumstances?If the answer is “yes,” we recommend that you stay home.

Should you choose to participate, you must have approval from your health care provider.

https://www.cdc.gov/coronavirus/2019-ncov/php/contact-tracing/contact-tracing-plan/appendix.html#contact



https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/index.html

2021 Summer Camp Special Needs Application A separate form is needed for each Individual.

This form is to be used to notify the Ventura County Council of any special dietary, health, mobility or disability needs your unit will have at Camp Three Falls. The Ventura County Council will make every reasonable effort to accommodate your special needs. It is the responsibility of parents and/or adults attending camp to make sure the person has everything the person needs at the time of the activity. This form will be submitted to the camp or activity personnel. Please be specific in explaining the needs and attach additional sheets if necessary. The contact person you list below may be contacted if camp staff has any questions.

Please use a separate sheet for each individual requiring accommodation. Please submit this form no later than two weeks prior to your arrival in camp.

Please check the session your scout is attending:

Scouts BSA Camp Sessions: #1 July 4 – July 10 #2 July 11 – 17

Webelos Resident Camp: Sessions: #1 June 30 – July 3

Name of person requiring accommodation:

Youth / Adult Unit #: Council: Parent / Guardian Name: Day Phone: Evening Phone: Email: Please check ALL those that apply. Dietary Allergies Asthma CPAP Machine Mobility Other* * List any additional information:

Parent / Guardian Signature: Date:

Camp menus will be published at www.campthreefalls.blogspot.com. If the menu doesn't meet this person’s dietary needs then accommodations must be met from home. See the reverse side for common special needs and assistance. Leader’s Name Street Address: City: State: Zip: Day Phone: Evening Phone: Email:

Email form to: [email protected] or Mail or FAX this completed form to:

Ventura County Council, Boy Scouts of America Attention: Summer Camp Director 509 East Daily Drive, Camarillo, CA 93010 Phone: 805-482-8938 Fax: 805-484-9172

Common Requests and Solutions for Special Consideration

Ventura County Council camps make every reasonable effort to meet the needs of campers, and have developed standard

solutions for common requests:

Food Allergies

The camp menu is posted online (www.campthreefalls.blogspot.com ) a few months before camp. Although it is subject to change,

it gives a good idea of the menu items planned. Our cooks are experienced in assisting campers with food allergies and can provide

substitute menu items in most cases. No peanut or tree nut products are used in our kitchen, but peanut butter (individual serving

packets) may be present in the dining hall. We are unable to provide detailed listings of ingredients in advance of camp because

menu items and ingredients from our suppliers may change. You can discuss concerns with the cook on arrival at camp. Please submit a Special Needs Form to enable the camp to anticipate the need. Vegetarian or vegan menu

The camp menu is posted online (www.campthreefalls.blogspot.com ) a few months before camp. Although it is subject to change, it

gives a good idea of the menu items planned. Camp can provide vegetarian or vegan alternatives with sufficient advance notice.

Please submit a Special Needs Form to enable the camp to anticipate the need. Sugar-free menu (diabetic) Camp menus are posted online (www.campthreefalls.blogspot.com) a few months before camp. Although menus are subject to

change, they give a good idea of the menu items planned. Camp can substitute sugar-free alternatives for many menu items.

Please submit a Special Needs Form to enable the camp to anticipate the need. Wheelchair access

The camp has at least one campsite which provides easier wheelchair access to tents, outhouses, and other campsite features. Submit a Special Needs Form to enable the camp to place the troop in an appropriate campsite. Limited-mobility access

Submit a Special Needs Form to enable the camp to place the troop in an appropriate campsite. Camp managers will make

every effort to place those with mobility challenges in campsites close to the center of camp. Submit a Special Needs Form to

enable the camp to place the troop in an appropriate campsite.

Vehicles in Camp

Private vehicles are NOT PERMITTED in camp. As vehicles present a safety hazard for pedestrians on camp roads, this rule is strictly enforced. In extreme circumstances we will assist with transporting disabled or injured individuals using a camp vehicle. CPAP machine (night-time breathing machine)

For campers with CPAP machines please plan for unit campsites that do not have electricity. Sleeping areas are not available in buildings at camp. To prepare for camp, two options are suggested:

Campers may consider purchasing a battery-operated CPAP machine. A good source for battery-powered CPAP machines is

www.cpap.com. If charging a battery-operated CPAP is required during daytime hours, the camp will provide an outlet.

Those who use a machine that requires 120v AC power (household current) can bring an inverter and an automobile battery. Camp will provide an outlet where automobile batteries can be recharged during daytime hours. Vehicles cannot be parked in or near campsites for the purpose of powering CPAP machines. Injections Camp personnel are not authorized to administer injections. Campers who require injections need to administer their own injections

or be accompanied by an adult trained and authorized (by parent/guardian in case of a minor) to administer injections for that

camper.

MERIT BADGE PREREQUISITES All Scouts must have a separate form for each merit badge. The forms will be collected by the Merit Badge instructor to

validate completion of the requirements while in camp.

FULL NAME:_________________________________________________ WEEK OF CAMP:____________

TROOP NUMBER:____________________ COUNCIL: ___________________________________________

MERIT BADGE APPLYING FOR: __________________________________________________ The Scout named above realizes that certain merit badges cannot be completed at Camp Three Falls unless prerequi-site requirements are met prior to arriving at camp. He also realizes that this form must be completed correctly, signed, and given to the camp merit badge instructor as verification that the requirements have been met. I certify that the above named Scout has met the following requirements (check those that apply):

___Astronomy-Requirement 6b ___Camping—Requirement 4b, 5e, 7b, 8d, 9a&b ___Cit. in the Nation—First Class or above. Do Req. 2, 3, 6, 8 in writing before camp ___Cit. in the World—First Class or above. Do Req. 3 & 7 in writing before camp ___Electricity—Requirements 2, 8, & 9a (bring written work to camp) ___Environmental Science—Requirements 3b & 6 (bring written work to camp) ___Fire Safety—Requirement 6a, 12 and complete Home Safety Survey ___First Aid—Requirement 5 ___Geocaching—Requirement 7 ___Lifesaving—Earn Swimming Merit Badge (Lifesaving MB requirement 2—changed for 2021). Pass BSA Swim

Test and swim 400 yards (at camp) before starting class ___Orienteering—Complete 2nd Class and 1st Class Map and Compass requirements ___Pioneering—Know all Trail to First Class knots and lashings ___Sustainability—Do requirements 1,2 (Water A, Food A, and Stuff A), and 3, all in writing ___Swimming—Pass BSA Swim Test (at camp) and all 1st Class swim requirements ___Weather—9a or 9b ___Wilderness Survival – Requirement 5 (bring Survival Kit to camp) For safety reasons and to ensure a Scout can be successful in completing the requirements, certain merit badges

have age restrictions. I certify that this Scout has enrolled in the following merit badge and meets the age requirements.

___ Metalwork (age 13) ___Climbing (age 12) ___Welding (age 14) ___ Rifle Shooting (age 12) ___ Shotgun Shooting (age 13) ___ Cycling (age 13)

_______________________________ ___________________

Scoutmaster Date

Campsite Inspection Criteria Tents

• Tents should be neat and orderly. Tent flaps should be left open; this is so that in an emergen-cy, staff can quickly confirm that no one is in the tent. Some tents will be missing ties; points should not be taken off if this is the case.

• The inside of the tent should be clean. Bedding (sleeping bags, pillows, and blankets) should be neatly arranged on the cot.

• Clothing should be folded neatly on top of the bedding, hung inside the tent, or stored in packs or baggage under the cot.

· Guy lines should be flagged with flagging tape. Tape is available from the camp ranger if need-ed.

• Clothes lines, if any, should be strung so that they do not present a ripping or strangling situa-tion. They should be out of pathways used by campers.

Fire Protection • The Unit Fireguard Plan must be posted. • We provide a rake, shovel and broom. These should be stored in the tool rack provided. • The hose should be neatly coiled and ready for use in an emergency. · The fire and sand buckets by each tent should be kept full.

Troop and Patrol Equipment • Duty rosters need to be filled out and posted. • A copy of the camp schedule should be posted. • All camping equipment should be stored away and clean. • The campsite should be identified with a troop flag or sign. A “sign” made by arranging rocks,

sticks, etc. is acceptable. • A first aid kit should be visible.

Campsite / Health / Safety • The common areas of the campsite should be kept neat and clear of litter. • The kybo should be clean. No trash or personal gear. Wash out the interior daily. • The hand washing station should be clean. No personal gear left at station (a shared soap dis-

penser is okay). Bonus

• New camp gadget each day. It’s okay to take down the previous day’s camp gadget and replace it with a new one that is substantially different (the inspector has the final say in whether it is “different” enough. Use of lashing should be visible. Tool holders, towel racks, tables, chairs, etc. lashed from rope or twine are examples of camp gadgets.

• Patrol flags should be displayed near the patrol’s tents. Evidence that the patrol is making flag will give partial credit. Full credit should not be given until the flag is complete.

Unit ________________________ Week ______________ Campsite ______________________________________

Possible Mon Tues Wed Thurs Fri Total

Tents

Area around tents is clear of litter 10

Personal equipment stored 10

Guylines flagged 5

SUBTOTAL 25

Fire Protection

Fireguard chart posted & filled out 10

Fire tools present & readily available 5

Hose neatly coiled 5

Water and sand buckets filled 5

SUBTOTAL 25

Troop & Patrol Equipment

Duty roster posted 5

Camp schedule posted 5

Equipment clean and properly stored 5

Troop sign or flag displayed 5

First Aid Kit in camp and visible 5

SUBTOTAL 25

Campsite/Health/Safety

Campsite neat & free of litter & debris 15

Kybo clean 5

Hand washing station clean and tidy 5

SUBTOTAL 25

Bonus

Camp gadget or gateway 5

Patrol flags displayed or being made 5

SUBTOTAL 10

GRAND SUBTOTAL 100

GRAND SUBTOTAL W/ BONUS 110

Daily Campsite Inspection

Scouts BSA Summer Camp and COVID-19

We understand that many families are concerned about their children attending Scouts BSA Camp during the COVID pandemic. Please rest assured that we are following all county, state and national guidelines in implementing our program, and going above and beyond those requirements in many cases.

While guidelines and best practices are changing weekly, current guidelines for youth activities—such as camps—include keeping campers divided into small groups called “cohorts,” with a maximum of 16 people per cohort. Fortunately, this works well with our normal organizational scheme in Scouts. All campers register as part of their troop. If the troop is small, it becomes their cohort. Larger troops may need to be split into smaller cohorts, typically by patrol. Very small troops may be combined into a single cohort for some activities.

• The troop/patrol/cohort will share a campsite. We provide two-person tents; at present, campers can only share a tent with another member of their household. Note that we have a limited number of tents, and if anyone wants a tent to themselves, they must bring their own tent – because of limited space, only one or two person tents are allowed.

• Cohorts will dine together in an outdoor, open-air setting. Each troop will be assigned one or two tables depending on the size of the group, and tables will be physically separated per county guidelines.

o All our staff has been trained in safe food handling and Covid safety by an outside public health approved vendor. Servings will only be handled by our staff using PPE. Campers will not be able to prepare their own servings.

o We will have our same high quality menu options available.

• The biggest change is or merit badge program and other daytime classes. If we are required to follow the cohort model – and at this point, we are planning for that possibility – Scouts will visit program areas ONLY with their troop/patrol/cohort.

o Our working plan is to group our traditional program areas into five “program groups.”

o At each program group, individual scouts will have a choice of several merit badges or other activities – so for instance, when the cohort visits the Outdoor Skills program group, each scout can choose to work on Trail to First Class or one of the traditional Scoutcraft merit badges. Not only will this ensure safety for all participants, it will guarantee a visit to every program area each day with a variety in the selection of merit badges available to serve both new and more experienced Scouts.

o We’re still working out details, and will inform registered troops as soon as we have more definite information available.

We have been excelling in planning for Summer Camp in the age of Covid. We continually find that our comprehensive plans pre-date national standards by weeks or months. This is a testament to the forward-thinking of our administration and our commitment to camper and staff health and well-being. The following is a non-exhaustive list of precautions we are taking to ensure a safe experience is had by all campers and staff:

• We are requiring that Medical forms and associated paperwork be turned-in to the Council Office earlier than years prior (two weeks in advance of arrival at camp) so that a more in-depth review can be undertaken prior to arrival at camp. As always, all three parts—A, B, and C—will be required to be completed in full;

• Pre-departure screenings by units prior to leaving for Camp Three Falls;

• On-Site health screenings prior to entering camp. Our natural camp layout will guarantee that all campers undergo a medical check prior to entering the premises;

• Temperature and health checks at least twice per day for staff and campers;

• Three-ply or equivalent masks will be required and worn by all individuals on-site;

• We will be installing additional hand-washing stations at strategic locations;

• Sanitizing stations and kits will be available at all program areas and placed throughout Camp;

• We hired two Assistant Rangers and extra kitchen aide to assist our Camp Ranger and cook with cleaning and sanitizing procedures;

• Common touch-points and areas will be cleaned and sanitized four times per day;

• Program areas will disinfect and sanitize all touchpoints and supplies before every session;

• All staff members will be required to take a specialized Covid-19 course;

• Additionally, all staff members will take a food handler certification course

• All dining will be outside, in a distanced, open-air setting by cohort;

• Food service will ensure the handling of food by specially trained staff members who will be wearing proper personal protective equipment; and

• We will be serving food at more than one location to minimize intra-cohort interactions; each service station will feature barriers to ensure a no-contact environment for campers.

The COVID vaccines will be a game-changer in making our summer camp environment safer for campers and staff. Adult staff and older youth staff will be required to get the COVID vaccine as available. If the vaccine is available to all before the start of camp we will require all adult campers and eligible youth campers to be vaccinated two weeks prior to arriving at camp. This will be similar to our tetanus vaccine requirement. As with many places of employment, we will require staff and campers to fill out a pre-camp screening questionnaire. All participants must expect to test negative prior to arrival through the end of June. This return of campers and the Summer Camp experience has

been long awaited. We hope all attendees will take the proper precautions prior to arrival to ensure the continued good health and safety of our Scouting family.

We will be sending out more information on how to complete health forms, medical dos and don’ts to prevent illnesses and our camp check-in procedure as we get closer to camp. This year we are requiring all units to turn in their medical and waiver forms two week before they arrive to complete the pre-check-in process and reduce the wait time and increased exposure in the parking lot created by the check-in bottle neck.

If you are a unit from Ventura County, please remember that there are council campership funds available to attend summer camp at Camp Three Falls. No Scout should be denied an opportunity to attend summer camp because of his family’s financial struggles. Click here to find the Ventura County Council Campership Application.

All of this remains a moving target. We are monitoring guidance from federal, state and local agencies and will adapt our plans as needed.

I hope this information helps to moderate the concerns of your leaders, scouts and parents, concerns we too have for our family and staff.

Jerry Thurston Camp Director Larry Tuck Program Director George Villalobos Scout Executive Ventura County Council

Webelos Resident Camp and COVID-19

We understand that many families are concerned about their children attending Webelos Resident Camp during the COVID pandemic. Please rest assured that we are following all county and state guidelines in implementing our program, and going above and beyond those requirements in many cases.

While guidelines and best practices are changing weekly, current guidelines for youth activities—such as camps—include keeping campers divided into small groups called “cohorts,” with a maximum of 16 people per cohort. Fortunately this works well with our Webelos Resident Camp operations. All campers register as part of their Den, which becomes their cohort. Some larger dens may need to be split into smaller cohorts; if we have two smaller dens from the same pack, we will combine them for some activities.

• The den/cohort will share a campsite. We provide two-person tents; campers can only share a tent with another member of their household, which means that Webelos youth will typically be sharing a tent with a parent. Note that we have a limited number of tents, and if anyone wants a tent to themselves, they must bring their own tent – because of limited space, only one or two person tents are allowed.

• Den cohorts will dine together in an outdoor, open-air setting. Each Den cohort will be assigned one or two tables depending on the size of the group, and tables will be physically separated per county guidelines.

o All our staff has been trained in safe food handling and Covid safety by an outside public health approved vendor. Servings will only be handled by our staff using PPE. Campers will not be able to prepare their own servings.

o We will have our same high quality menu options available. • Dens have always participated in camp activities as a group, round-robin style, and we’ll continue to do that

this summer, with additional measures to ensure that cohorts do not interact in program areas.

We have been excelling in planning for Summer Camp in the age of Covid. We continually find that our comprehensive plans pre-date national standards by weeks or months. This is a testament to the forward-thinking of our administration and our commitment to camper and staff health and well-being. The following is a non-exhaustive list of precautions we are taking to ensure a safe experience is had by all campers and staff:

• We are requiring that Medical forms and associated paperwork be turned-in to the Council Office earlier than years prior (two weeks in advance of arrival at camp) so that a more in-depth review can be undertaken prior to arrival at camp. As always, all three parts—A, B, and C—will be required to be completed in full;

• Pre-departure screenings by units prior to leaving for Camp Three Falls; • On-Site health screenings prior to entering camp. Our natural camp layout will guarantee that all campers

undergo a medical check prior to entering the premises; • Temperature and health checks at least twice per day for staff and campers; • Three-ply or equivalent masks will be required and worn by all individuals on-site; • We will be installing additional hand-washing stations at strategic locations; • Sanitizing stations and kits will be available at all program areas and placed throughout Camp; • We hired two Assistant Rangers and extra kitchen aide to assist our Camp Ranger and cook with cleaning

and sanitizing procedures; • Common touch-points and areas will be cleaned and sanitized four times per day; • Program areas will disinfect and sanitize all touchpoints and supplies before every session; • All staff members will be required to take a specialized Covid-19 course; • Additionally, all staff members will take a food handler certification course • All dining will be outside, in a distanced, open-air setting by cohort;

• Food service will ensure the handling of food by specially trained staff members who will be wearing proper personal protective equipment; and

• We will be serving food at more than one location to minimize intra-cohort interactions; each service station will feature barriers to ensure a no-contact environment for campers.

The COVID vaccines will be a game-changer in making our summer camp environment safer for campers and staff. Adult staff and older youth staff will be required to get the COVID vaccine as available. If the vaccine is available to all before the start of camp we will require all adult campers and eligible youth campers to be vaccinated two weeks prior to arriving at camp. This will be similar to our tetanus vaccine requirement. As with many places of employment, we will require staff and campers to fill out a pre-camp screening questionnaire. All participants must expect to test negative prior to arrival through the end of June. This return of campers and the Summer Camp experience has been long awaited. We hope all attendees will take the proper precautions prior to arrival to ensure the continued good health and safety of our Scouting family.

We will be sending out more information on how to complete health forms, medical dos and don’ts to prevent illnesses and our camp check-in procedure as we get closer to camp. This year we are requiring all units to turn in their medical and waiver forms two week before they arrive to complete the pre-check-in process and reduce the wait time and increased exposure in the parking lot created by the check-in bottle neck.

If you are a unit from Ventura County, please remember that there are council campership funds available to attend summer camp at Camp Three Falls. No Scout should be denied an opportunity to attend summer camp because of his family’s financial struggles. Click here to find the Ventura County Council Campership Application. All of this remains a moving target. We are monitoring guidance from federal, state and local agencies and will adapt our plans as needed. I hope this information helps to moderate the concerns of your leaders, scouts and parents, concerns we too have for our family and staff.

Jerry Thurston Camp Director Larry Tuck Program Director George Villalobos Scout Executive Ventura County Council

ventura county council boy scouts of america

Documents