Camp Cherry Valley - Greater Los Angeles Area Council

Transcripción

3450 E. Sierra Madre Blvd.
Pasadena, CA 91107
626-351-8815 Ext 249
San Gabriel Valley Council
Boy Scouts of America
San Gabriel Valley Council -
Camp Cherry Valley
About Camp Cherry Valley
Camp Cherry Valley is know
for:

Great Staff—Their goal
is for your unit to have
an amazing time at
camp!
Located on the leeward side of the west end of Catalina Island, twenty-two miles from
the Southern California Coast, Camp Cherry Valley has much to offer. Unique, native
wildlife roams the 157 acre camp under the canopy of the native Catalina Island Cherry
trees. The calm, crystal-clear cove waters are a safe haven for hundreds of species of
marine life.

Great Food—Wonderful
meals, full salad bar.
Our staff makes sure
you and your scouts
don’t go hungry.
Established in 1921, the camp was originally operated by the Pasadena Council by
Camp Director Skipper Robison. He established traditions that are still alive today, most
notably the Tribe of Torqua, the Camp Cherry Valley Honor and Leadership brotherhood. Scouts who return to
Cherry Valley advance within the ranks of the Tribe.

Great Program— Staff
take pride in delivering
a top knock program.
Leaders MeetingApril 27, 2013 9 am
Smiser Scout Center
3450 E. Sierra Madre Blvd.
Pasadena, CA 91107
Camp Program areas include the Rifle and Archery ranges, Nature and Outdoor Skills areas, and Camp Cherry
Valley's famous Waterfront. There is always something to do with activities to suit your liking, regardless of age
or ability. You can take a self-guided nature trail tour while identifying native plants along the way. You can
join your troop on a snorkel tour, led by the knowledgeable and friendly staff. You can even experience marine
wildlife up close in our Aquarium. After kayaking around the cove, you can challenge your friends to a shootoff at the rifle range to see who can make the dime club. Of course, there are always merit badges to be earned
as well- from Pioneering to Environmental Science and from Lifesaving to Geology.
www.sgvcbsa.org
Inside this guide:
Payment/Refund Policies
2-3
Travel Information
4
Packing List
5
Camp Rules, Procedures
6-8
Camp Facilities
9-10
Program Opportunities
10-21
Scuba Form
22-23
Week at a Glance
24
Merit Badge Form (sign up)
25
Permission Form
26
Merit Badge & Trask Form
27
Medical Form (complete)
28-49
Map with Boat times
Campers stay in platform tents on raised deck campsites, where cots and mattresses are provided. Nearby are the
restroom and shower facilities. The Camp Store provides snacks and souvenirs, just a trails turn from the Archery and Rifle ranges. The Health Lodge is located centrally, as is the Program Office- the central hub of camp
information. The Dining Hall can accommodate 160 campers at once, where meals are done in two shifts.
50
Welcome to camping with the San Gabriel Valley Council!
This guide will help answer your questions about what your week at camp will be like. In the following guide
you will learn about our camp, the grounds, how the programs operate, and everything that you will need to
bring to make this a trip to remember. This guide is set up to give you information about Camp Cherry Valley
on Catalina Island.
2013 Camp Cherry Valley Dates
Week 1—June 9-15 canceled
Week 4—June 30-July 6
Week 7—July 21-27
Week 2— June 16-22
Week 5—July 7-13
Week 8—July 28-Aug. 3
Week 3—June 23-29
Week 6—July 14-20
Week 9—August 4-10
NONDISCRIMINATION CLAUSE
The San Gabriel Valley Council and their Camp staff maintain a policy of nondiscrimination.
Camp Cherry Valley
Getting Set For Camp…..
Camp Payment Plan:
Work yard fence with
signs units have made
and left at camp to show
they were there.
1.
Deposit of $200 per unit is required at the time of making a reservation. This deposit is nonrefundable, but is applied to your final total.
2.
First payment of $100 per person is due no later than Wednesday, October 31, 2012. This payment
is non-refundable but transferable only to a replacement scout or adult in your troop. If you neglect
to make a payment, your unit’s reservation will be dropped and you will forfeit all money paid.
3.
Second payment of $100 per person is due no later than Thursday, January 31, 2013. This payment
4.
Third payment of $100 per person is due no later than Thursday, February 28, 2013. This payment
5.
Fourth payment of $100 per person is due no later than Thursday, March 28, 2013. This payment is
non-refundable but transferable only to a replacement scout or adult in your troop. If you neglect to
make a payment, your unit’s reservation will be dropped and you will forfeit all money paid.
6.
Early payment discount of $10 per paying person is available if the entire reservation is paid in full
by Wednesday, May 1, 2013. Otherwise, final payment of all balances is due no later than thirty
(30) days prior to the start of your camping week.
7.
There is one free adult with each reservation. Please note that your statement reflects only the
paying adults. Your total number of adults is the number on the statement plus one. All additional adults pay the full fee.
8.
There is a $10 discount for pairs of brothers attending camp together. The price per pair can be reduced by $10 (or $5 per brother). This is applicable to scouts only.
Cherry Valley
Leaders Guide
Payment methods include cash, check, VISA, MasterCard, Discover or American Express. Checks should
be made payable to SGVC – BSA. Please note - the above payments are non-refundable and are
transferable only to a replacement scout or adult in your troop. Your help in following this schedule
will allow the scouts in your troop to budget for camp, as well a helping our council provide the maximum
number of spaces possible to scouts who wish to attend. Thank you for your help!
Payments should be mailed to:
San Gabriel Valley Council, BSA
3450 E. Sierra Madre Blvd., Pasadena, CA 91107
For more information or questions, please don’t hesitate to contact the camping department at 626 3518815 ext 249 for Sonia
Unit Loyalty Plan
Starting the summer of 2013, the San Gabriel Valley Council will offer units a reward for attending
camp! Attend Cherry Valley 3 consecutive years in a row and receive the following:
 Year 2 (2014) of attendance – 1 extra free adult
 Year 3 (2015) of attendance – 1 extra free adult and 1 free Senior Patrol Leader
More unit signs on display...
Page 2
Please Note: Missed payments can result in the loss of your reservation. Total camp fees are due 30
days prior to your scheduled arrival at camp. All troops who pay total fees by Wednesday, May 1st
will receive the $10 per person discount. All campers who have not paid in full by Wednesday, May 1st
will have to pay full campers fees, thus negating the discount.
Camp Fees
With each reservation there is one free adult. All other adults pay full price. All payments must be made
30 days prior to the start of your camp week.
Brother discounts are $10 off the second and third pairs of brothers who attend together. This discount should be taken at time of final payment, please call us to adjust your statement and provide the
correct amount of your final payment. Adults who replace leaders during the week can share fees.
Adults coming to camp who do not replace a leader in their troop will be charged at a rate of $65 per person per day (this includes room, board, and meals). Please notify program office of any leadership
changes during the week. New leaders must check-in upon arrival.
The BSA summer camp fee for:
In Council is $585 per person
Out of Council is $625 per person
**All campers who travel to and from camp on other than the boats reserved by the council are
responsible for covering their own transportation costs.**
Scouts walking back to their
campsite from the water-
Camp Refund Policy
Please note - the above payments are non-refundable and are transferable only to a replacement
scout or adult in your troop. Payment-in-full is expected no later than 30 days prior to the start of
your camp week. Any drop in the number of scouts or adults, after that point, will result in no refund of money already paid and the remaining balance is still owed.
Camperships
Funds are available to supplement Scout fees for those who are MEMBERS OF THE SAN GABRIEL
VALLEY COUNCIL and can demonstrate a need for this support. Information and applications are
available through the San Gabriel Valley Council website www.sgvcbsa.org.
“Come for summer
camp, get the
adventure of your life”
Leadership Requirements
The role of adult leaders at summer camp is very important. In planning, supervising, teaching, and participating, their influence and support is critical. Start recruiting your leaders early and have alternates
standing by. Two registered adults are required per troop. Usually the Scoutmaster and Assistant
Scoutmaster attend; however, if other adults will be bringing the Scouts to camp, start preparing them
early. At least one adult must be 21 years of age or older; the other must be at least 18 years old. Adult
supervision is a critical component of a successful youth program. The leadership and guidance you provide your Scouts during your stay will maintain their safety. We ask our staff to lead by example and
would ask you to do so as well. Please help us follow all written, spoken, and implied rules and regulations as they are in place to protect the children, adults, staff, facility, equipment, property, and environment..
WE RECOMMEND, BUT DO NOT REQUIRE, A HIGHER ADULT TO CAMPER RATIO FOR
YOUNGER SCOUTS. FOR SCOUTS UNDER 13 WE RECOMMEND 1 ADULT TO EVERY 8
SCOUTS. OVER 13 WE RECOMMEND 1:10. THE BSA ONLY REQUIRES 2 DEEP LEADERSHIP AT ALL TIMES.
Page 3
Waterfront view...
Camp Cherry Valley
Tour Plan
The BSA National office requires that troops file a tour plan when traveling to activities. Contact your
local Scout Office for the proper form and further information. Please have a copy of your completed
and approved tour plan to show the staff.
Special Requests
FOOD: If you have special dietary needs, please let us know in writing and/or by telephone at least two
weeks before your arrival. We are happy to do what we can to meet your needs. However those with
very restrictive diets will need to make arrangements to bring specialty items to camp. Arrangements will
be made to store and prepare foods brought to camp for those individuals.
Cherry Valley Dock
The San Gabriel Valley Council cannot be responsible for lost, stolen, or damaged articles while in
transport or while in camp. Please mark all property plainly.
Getting to Camp… Travel Information
PARKING:
Parking is $15 per 24
hours and an additional
$15 for any part of 24
hours after the first day.
Payable via Cash,
MasterCard, or Visa.
There is an ATM
machine available at the
terminal.
Troops will arrive on Catalina Island via Catalina Classic Cruises. The boat fare is included in the cost of
camp. The boat will depart from the Catalina Express Terminal, near the Queen Mary, at the Port of Long
Beach, 1046 Queens Highway, Long Beach, CA. Departure times are located on the map at the back
of this guide. As in all activities at Cherry Valley, you should be punctual. One hour early is not too
early. Upon arrival, you will be met by two staff personnel who will take your official troop count and
give you boarding instructions. The trip across the Channel takes approximately two hours.
Any additional transportation costs are not provided. Travel mid-week back to the mainland, or water
taxis from Two Harbors to Camp must be paid for out of pocket. Any Adult leaders or parents who have
arranged a mid-week visit or leadership swap should arrange their tickets with Catalina Express. They
should call as early as possible to secure a reservation. There are usually tickets available, but there are
luggage restrictions. Their number is 310-519-1212.
TO MAKE RESERVATIONS TO TRAVEL MID-WEEK, CALL AS EARLY AS POSSIBLE. STANDBY
SEATS ARE USUALLY AVAILABLE. ALL SERVICES REQUIRE EARLY CHECK IN AND HAVE LUGGAGE RESTRICTIONS. ALL COSTS ARE THE RESPONSIBILITY OF THE INDIVIDUAL. BE SURE
YOUR BOAT IS TRAVELING TO TWO HARBORS FROM SAN PEDRO. THE CATALINA EXPRESS
TELEPHONE NUMBER IS: (310) 519-1212.
COMING FROM A LONG DISTANCE?
Troops can stay at Camp Trask before or after their trip. Sleep under the stars; enjoy swimming, dinner
and breakfast before you leave for your Cherry Valley adventure! Additionally, we are now offering an
optional sack lunch to take with you to the boat. A reservation form is available at the end of this guide.
We will send directions to Camp Trask with confirmation of your reservation.
MONDAY TRAVEL
We are happy to arrange for Monday travel for those troops in need. Troops arriving in Camp on Monday
will be met in Two Harbors by the camp truck for the transporting of their gear to the camp. One adult
leader will be driven to the camp for the purpose of registering their troop, while the rest of the troop hikes
into camp.
Remember, returning from camp on Saturday will be via Long Beach on the Boy Scout boat, so
accommodations will need to be made to have transportation from Long Beach back to your vehicles
in San Pedro.
ARRIVING AT TWO HARBORS:
Scouts walking back into camp
from the waterfront.
Page 4
Once in Two Harbors all Scouts and adult leaders will have their luggage transported by camp vehicles,
while scouts and leaders hike the 1.5 miles into camp. Any leader or Scout with a disability that prevents
them from hiking into camp will be transported to camp by van. Shore boats to camp are available at
about $5 per person each way. Please know that this service is provided only for those people who are
unable to make the hike.
PLEASE MARK EVERYTHING WITH YOUR NAME AND UNIT
What to Bring to Camp
Personal Equipment List: (Please identify luggage
with a RED tag)
 Gear Bags - military type duffel bag is best
 Sleeping Bag—50° degree or warmer
 Jacket or Hoodie
 Class A Scout uniform - must be worn while
traveling to and from camp
 Swim trunks and beach towel
 Shower towel
 Toilet kit: toothbrush and paste, soap, shampoo, lip balm, eye care, etc.
 Personal medication
 Flashlight w/ extra batteries
 Change of clothes- long pants, shorts, and
shirts
 Socks—bring more than you think you’ll need
 Hat—preferably wide brimmed
 Scout Handbook
 Sun Screen







Watch
Canteens or water bottles
COMPLETED MEDICAL FORM
Small personal first aid kit
Day pack—large enough to fit food and water
for a day
Lace-up Hiking Shoes– NOTE: slip on shoes
are not hiking shoes
Water Shoes or sandals—for water activities
and when showering
Notebook, Pen or Pencil for merit badge work

 Fishing Pole, bait & tackle (optional)
Teepee at Cherry Valley near
merit badge class area by
mine and waterfront.
Troop equipment list:
Please bring a collapsible pole for your troop flag.
Troops must provide their own flag pole.
1. Troop flag and flagpole—must be in a hard case.
3-4” PVC pipe works great. Mark with CCV and
red tape.
DO NOT BRING TO CAMP
Anyone who brings any of the below listed items is subject to removal from camp at
their own expense








Weapons—firearms, spears, machetes, etc.
Fireworks
Valuables
Spear guns
Matches or flammable liquids
Alcohol and Drugs
Animals
Personal Sporting Equipment, including bicycles








Propane or liquid gas lanterns or stoves
Ice Chests
Tents
Tarps or poles
Pole Spears
Sheath Knives
“Remember, you are
in for a week of
adventure!”
Cell Phones—Scouts
Vehicles
Packing your gear
Mark your gear with a red ribbon or tag, and the letters CCV. Once you get to Long Beach, your gear will
be moved around many times and will not be under your supervision until you get into camp. Do not attach anything to your bag. Fishing poles must have a hard case.
Use your day pack to carry items you will need with you on the boat and on your hike into camp. This
may include food, or snacks, but every scout should carry at least one water bottle. The Scoutmaster must
collect all troop Medical Forms before crossing the channel and will redistribute them to every camper
upon arrival in camp. This will ensure that every camper has their medical form in hand at the time of
check-in. The Scoutmaster must also carry the troop roster and any fee payment receipts.
Page 5
Merit Badge instruction
Camp Cherry Valley
Camp Rules, Procedures and Policies
Please understand that the purpose of camp rules is to ensure the safety of all those who will be living together at camp.
Emergency procedures and information
As part of the first flag ceremony, the camp will participate in the camp’s emergency alarm. Any other
alarms during the week will be real. If you hear the alarm, walk to the parade grounds, join up with your
Troop, and ensure all are accounted. Further instructions will be presented at the parade grounds. Fire is
the greatest danger facing the camp and special attention needs to be applied to ensure that all campers
understand this threat.
A Scout is prepared!
First Aid
The Health Lodge is designed to meet the emergency needs of our campers. We are ready with emergency
support and will make necessary contact with the Emergency Medical System in the area. We will store
all medications that require refrigeration and will assist with dispensing as needed. Because of the high
cost of medical supplies for common ailments, it is important that all Scoutmasters bring over-the-counter
medications and first aid supplies for Scouts in their troops who get colds, headaches, sore throats, or
coughs. Some of these medications will be available for sale in the Trading Post to any adult leader, but it
is best to bring your own. They will not be available in the Health Lodge except in emergency situations.
WE ENCOURAGE EACH SCOUT TO BRING THEIR OWN PERSONAL FIRST AID KIT TO CAMP
AND EACH TROOP TO BRING A TROOP FIRST AID KIT. MINOR CUTS AND FIRST AID ISSUES
PROVIDE OPPORTUNITIES FOR SCOUTS TO PRACTICE THEIR FIRST AID SKILLS. AND
SHOULD BE TAKEN CARE OF IN THE CAMPSITE BY THE SCOUT OR ADULT LEADERS.
Youth Protection
Cherry Valley
Leaders Guide
The Boy Scouts of America is a leader in the fight against child abuse. We must do everything in our
power to prevent physical, emotional, and sexual abuse. To protect youth and adults we must be extremely careful and follow the BSA TWO-DEEP LEADERSHIP policies. We will not tolerate any activity that can, in anyway, be interpreted as abusive. If you are aware of anything questionable please report it at once to the Camp Director. Do not become directly involved as an individual unless there is an
immediate physical threat to the camper.
Campsite Procedure
The campsite is your Troop home at camp. Your Camp Friend and Commissioner are there to assist you,
if necessary. The Troop’s conduct, while in the site, will be the responsibility of the units’ adult leaders.
Please instruct your Scouts to respect other Scouts and troop campsites. Do not enter them unless invited.
Failure to respect other troop campsites and personal belongings could result in individual or troop expulsion from camp. Control noise, respect quiet hours, and leave other people’s personal property alone.
Damage to tents and campsite equipment will be charged to the Scout troop.
Quiet Hours
We are required to provide all campers with at least eight hours of quiet time. Between 10:00 PM and
6:00 AM each day we ask that you enforce this quiet period. If there is a problem in your campsite or with
campers from another troop, please notify one of the commissioners living in the cabins adjacent to the
campsites. Please do not take matters into your own hands to solve the problem.
View of a campsite
Cleaning Squad
Immediately following breakfast and dinner, one camper from each troop is asked to meet the Ranger to
help clean the Grove restroom facility and shower house. Further information regarding time and meeting
places will be given to you by your commissioner upon arrival at camp.
Page 6
Alcohol and Smoking Policies for Adult Leaders
No Alcohol is allowed in camp. The Camp Director will expel anybody violating this rule.
Los Angeles County fire code requires all smoking to be done in the one designated smoking area of
camp. In addition, the San Gabriel Valley Council’s policy on smoking is the same as the BSA - always to
be done with discretion and not in the presence of the Scouts.
Checking out of Camp
The council requires the following of adults leaving camp:
1.
2.
3.
Adequate adult leadership remains in the camp to oversee the needs of the Troop. Note: The twodeep leadership policy must always be followed.
Adults should check out with the Program Office; so in the case of an emergency the adult can be
located.
Scouts leaving camp early must be picked up at camp by a family member authorized in their camp
paperwork. A phone call must be placed to the parent or guardian who signed the release to confirm
that the Scout is authorized to leave with that adult.
Scout Law path
Campsite and Program Equipment
The Commissioner and Scoutmaster will conduct an inventory of all campsite equipment when arriving in
camp. Damage that may occur during the week will be assessed with the Troop. Report any damage as
soon as it is noticed. Campers must do their best to keep campsite equipment in working order. Adult
leaders should monitor the campsites to assure no intentional damage comes to campsite tents, tables,
decks, or signage.
Program Equipment
The San Gabriel Valley Council provides all troops
with the opportunity to use high quality program
equipment during a week of camp. Normal “wear
and tear” of equipment is expected. Careless or
intentional mistreatment of equipment will not be
tolerated. Campers should take care of, and have
respect for, all camp wide equipment and facilities
including:
1. Shower and restroom facilities, camp buildings, and structures
2. Other camper's personal belongings.
3. Program equipment and facilities, including:
 Waterfront

Masks, snorkels, fins, PFDs, and rescue
equipment

Boats- Kayaks, Rowboats, Canoes, and
Sailboats

Fences, lines, buddy-boards, and structures

Page 7
Aquatic life and tanks in the Sea Lab
“A week of camp life
is worth six months of
theoretical teaching in
the meeting room.”
 Shooting Sports

Rifles and ammunition, Bows and Arrows

Fences, lines, and structures
Lord Baden-Powell
 Nature and Outdoor Skills


Handicraft tools and work-benches
Nature signs, trail markers, and posters
The San Gabriel Valley Council is proud of its
camp equipment and facilities. All campers are
asked to use the equipment as intended and to have
a great time in doing so. Equipment, facilities, and
property will need special attention to keep it in
good working order and available to all campers
throughout the year.
Campers who intentionally or maliciously break
camp equipment will be expected to pay for the cost
of replacing the product. Please contact the Camp
Director if someone in your Troop damages equipment.
Waterfront equipment
Camp Cherry Valley
Phones
Public phones are not available in camp. If campers wish to contact their parents, they need to use their
adult leaders’ cell phone. A charging station will be available for Adult Leaders only. Do not bring your
own power strip. All leaders charging cell phones are responsible for their security. Camp Cherry Valley
is not responsible for cell phones that are lost or stolen. Scouts are encouraged to not bring cell phones
to camp. If there is an emergency, please feel free to use our business number at camp is (310) 510-2895.
When leaving a message for a camper please include the name and troop number of the person.
Scout should NOT bring
their cell phones to
camp.
Wi-Fi Policy
WIFI is available in Camp. Check with the program office for more details.
Day Visitors
Cherry Valley
Leaders Guide
All Day visitors must immediately report to the program office to check in and receive a visitor
pass. This is part of our intrusion policy and shows our staff you are an authorized guest. All
Day visitors to camp may buy meal tickets per person, which will be paid to the Business Manager in the Program Office. Any visitor who does not come with a completed and signed BSA
medical form, will not be permitted to use the camp program equipment.
Camp Mail
Mail delivery to the island varies with the weather and other factors. It is suggested that those
parents wishing to mail their Scout a letter or care package do so the Thursday or Friday before
the Troop leaves for Camp. Most packages mailed later than this will not arrive in camp during
the week of camping. Please do not mail money, as it may get lost in the mail. An ATM is
located in the town of Two Harbors for emergencies. Please address mail as shown below:
How to address your packages and letters:
Scout Name
Unit Number
Camp Cherry Valley
Send a care package
PO Box 5067
Avalon, CA 90704
Page 8
Ecology at Camp
1. Animal Conservation: Please make certain that all Troop members understand the
delicate balance of plant and animal life on Catalina Island. Everyone should do
their best to ensure that no animals are harmed or killed. This applies to marine as
well as land life. Please walk only on designated trails and roads.
2. Pets: No pets of any kind should be brought to camp. Pets are a threat to wildlife
and are in danger themselves.
3. Plant Conservation: The vegetative life on the Island and in the sea is very fragile.
Please make every effort to stay on the trails, do not pick the flowers, or collect
specimens. Do not gather firewood or use natural materials for camp construction
projects. The cherry trees are our special charge. Please do all you can to prevent
name carving, hammock hanging, and other acts that damage the trees.
4. The Salina is an environmentally protected area that is vital to the health and wellbeing of the cove. Please help us keep the Scouts from walking through it or destroying it in any way.
Waterfront view
5. Fire: The smallest spark is a deadly threat to wildlife and campers. No fireworks,
open fires, flame utilizing lamps, or other equipment can be allowed in camp.
6. Please help us keep the campers on the roads and designated trails, as this will help
protect the animal habitat and plant life from destruction.
Camp Facilities
“The camp is full of
wonder, you just have
to find it”
Camp Store
CCV has a great store, which provides books, camp gear, snacks, and program supplies. Other items
available are batteries, stamps, toiletries, soda, and camp memorabilia. The camp will provide each
camper with the current year’s patch and a leather totem to collect beads. The average Scout will spend
between $45 and $60. The Trading Post will open at 6am daily to serve coffee and morning snacks to adult
leaders. WIFI service is available at the trading post.
Shower and Restroom Facilities
CCV provides shower and restrooms for all campers. Women, Men, and boys all have separate shower and
toilet facilities. Swim trunks and water shoes or sandals must be worn in group shower facilities at all
times. These facilities are always available to campers, but should be used before quiet time- 10:00pm.
Maintenance of the facility is the responsibility of all who use it and all will be given the opportunity to
assist in cleaning it. Report any malfunctions to Staff Personnel at once.
It is highly recommended that each troop organize and implement troop shower times. By having an adult
posted outside the boy's shower facility, the boys will be less likely to engage in horseplay. If there are
any difficulties with other campers, report it to staff.
Page 9
Separate showers for
women, men and boys.
Camp Cherry Valley
Dining Hall
The camp will be split into two groups for meals. The Starboard Watch will eat first at each meal, followed by the Port Watch. Each troop will be assigned to a watch for all meals throughout the week. All
members of your troop must eat at their assigned watch. During your meal time, your troop will be assigned specific tables to eat at during the week.
WAITER DUTY
Dining Hall
Each unit should provide one scout for every table used by their Troop to serve as a waiter for each meal.
The waiters will:
1. Report to the Dining Hall fifteen minutes before the troop’s watch.
2. Set tables, wipe down table, and clean the area around tables after the meal.
3. Accept further direction from the dining hall staff.
DINING PROCESS
Each troop will be assigned to either the Starboard or Port Watch to eat every meal. Starboard Watch
always eats first; Port Watch always eats second. Fifteen minutes before every meal, the troop must send
one scout per table to serve waiter duty. They will prepare their table before the meal and clean it up afterward, as per the instructions from the Food Service staff. Troops will assemble at the parade grounds just
before each meal time. Grace will be offered and then the troops will move inside for their meal. Troops
will move through the front doors of the dining hall and receive their food cafeteria style. A breakfast bar
with fruit and cereal is available at breakfast and a salad bar at lunch and dinner. The waiters will have
already prepared tables with punch and condiments. It is very important that each unit sits at the table assigned. If you are sharing a table with another Troop, please coordinate a waiter rotation schedule with
them.
Cherry Valley
Leaders Guide
Program Opportunities
Along with the great locations and staff, our camp programs are the best anywhere! Scouts and leaders
will be challenged to fit merit badge courses, free-time elective activities, and special programs into a busy
week of camp. Pre-planning is essential! Check out our great programs.
Camper Totem
Each Scout will be given a leather totem. Throughout the week, each camper will be recognized for participation in programs. This is done by presenting colored beads for each activity they have participate d
in. While some beads will be earned through program participation, other beads are elective. As part of
our camp Intrusion Policy, the camp asks that each adult camper wear their totem at all times. This allows
staff to quickly discern between adult campers and unwanted visitors.
Totem Bead Color Chart
View from camp
Page 10
COLOR
ACTIVITY
COLOR
ACTIVITY
Red
Opening Campfire
Blue
Honor Trail
Yellow
Scouts own
Turquoise
Ocean Adventure
White
Service Project
Brown
Kybo
Orange
Tuesday night Cobbler
Gold
Grace at a meal
Black
Hike Day
Clear Sparkle
Flag Ceremony
Green
Commissioner Games
Dark Blue
Sea Lab Tour
Light Blue
Waiter Duty
“Special”
TBA
Tribe of Torqua
The Tribe of Torqua is Camp Cherry Valley's leadership and honor society. For over 90 years, scouts and
adults who come to Cherry Valley have advanced within the tribe, through the ranks of Brave, Warrior,
Medicine Man, Chief, and Tribesman. The Senior Patrol Leader is responsible for keeping track of each
scout's progress throughout the week. Should a scout fulfill the requirements, he will be inducted into the
Tribe. Inductees will be given an Arc patch at the end of the week. The Arcs go around the round Torqua
patch available for sale in the Trading Post.
Campfires
The Camp hosts three campfires during the week. The camp staff perform in the opening and closing
campfire for the campers. The Commissioner Campfires on Wednesday night are opportunities for the
scouts to perform in front of the camp. Your troop should come with skits or songs prepared, but if your
troop does not know any appropriate campfire skits or songs, your troop friends can aid you. Each troop
will be given the opportunity to perform 2-3 skits or songs. The Commissioner will pre-screen and approve all skits and songs.
Sailing
Troop Service Project
We provide opportunities for your Unit to perform service projects while in camp. The camp will tailor
projects to your Troop's age and skill level. We are always looking for people who would like to help our
camp become even better. Anyone interested in joining our support team, please notify the Camp Director.
Honor Troop Award (Ribbon)
Each troop will have the opportunity to earn the Camp Cherry Valley Honor Troop Award as they participate and progress through the programs during the week. This award honors those Troops who take an
active role in promoting the values of Scouting through their service to the camp. This is not a competition
between troops, but against the standard of the tradition and excellence of the Camp. Scoutmaster, Commissioners, Senior Patrol Leaders, and Camp Friends will work together to ensure success. Ribbons will
be presented to each Troop to designate the level of excellence they have obtained. The forms for tracking
in-camp advancement and recognition will be given as part of the check-in material when you arrive at
camp.
“See things from the
boy’s point of view.
Lord Baden-Powell
Highland Games
Thursday night is a special night for our campers. The Highland Games have been a Cherry Valley Tradition for years. Campers participate in friendly competition with others, featuring challenging and rowdy
games, like Tug of War, the rope game, arm wrestling, and Bat & Moth. Since 2011, troops can also forge
the perfect team for a camp-wide challenge- the Scout Skills Relay. Scouts team up to identify native
plants, set up tents, tie knots, shoot arrows, perform first aid, and perform various team-building exercises.
Highland Games
Honor Trail
After the Highland Games and the Scout Skills Relay have been completed, the troops move onto the
Honor Trail. Hiking at dusk up along the road that encircles Camp Cherry Valley, scouts will hear from
the four commissioners, who will speak regarding the Scout Oath. Drawing on their personal experiences,
each commissioner will relate to the troops how scouting has changed their life. This opens the door for
serious, profound discussion back in your campsite.
Page 11
Photo by Aimee Barker
Camp Cherry Valley
Hike Day
Hiking on Catalina Island is a unique experience. The Island boasts spectacular vistas and easy
or difficult terrain. Wednesday is hike day for Cherry Valley campers. Each troop selects one
of several locations and spends the day hiking with experienced Troop friends. The hikes we
offer differ in difficulty, length, and terrain, so be sure to work with your Senior Patrol Leader
and troop to select a hike that works for everyone. Each scout will be given a lunch to pack on
the trail, with a sandwich option of Turkey, Ham, or Peanut Butter and Jelly. Program areas
will be closed all day, but the Trading Post will open in the afternoon. Pack inspections will be
done by Troop Friends to ensure that every scout has the proper equipment for their hike- (i.e. suffiMap of the island.
cient water, proper hiking shoes, a hat, first aid kit, etc.). Hike day patches are available in the Trading
Post, including rockers for each hike accomplished!
Silver Peak
Hike Day
This is a 17 mile hike to the highest peak on the West End of Catalina Island, an altitude of
1804 ft. The hike takes the better part of the day, even for the physically fit. Hats, canteens,
proper, broken-in hiking shoes and sunscreen are necessary equipment and must be brought to
camp by the hikers. This hike requires training prior to arrival at camp, it is NOT for scouts
NOR adults who do not regularly hike or are not in hiking condition. Troop friends will inspect
packs, shoes, footwear and water supply prior to departure from camp. The hike to silver peak
offers many scenic vistas of the west end sights that most tourists do not see. This includes
fabled Iron-Bound Bay, the impressive Eagle Rock, and Land's End- (the westernmost tip of
Catalina). Scouts participating in the ACE program for the week, may use Silver Peak as their
ACE hike.
Shark Harbor
View of the dock.
Page 12
This 16 mile hike is a challenging but highly rewarding hike. Starting early in the morning,
hikers walk into Two Harbors, then follow the Banning Trail road up 1200' to the ridgeline.
They then follow the ridge, traveling south-east until they reach Little Harbor. On clear days
hikers may see San Clemente Island on the way. Once to Little Harbor, it's a short distance to
neighboring Shark Harbor, where the swells from the open ocean will greet them. Various water toys- (boogie boards, skim boards, etc.), will be available for play once they arrive. After
lunch and water time, hikers will travel back to camp by the main road, through the interior of
Catalina Island. It is not uncommon for Shark Harbor hikers to come across Catalina's famous
bison. The ACE program will do this hike every week. Adults or scouts over 14 wishing to
join the ACE hike may do so, even if they are not participating in the rest of the ACE program.
Proper adult leadership is expected to be with the rest of the troop. Although not as physically
demanding as the Silver Peak hike, it is required that all hikers be in hiking shape, with the
proper hiking attire and gear- (hat, broken-in hiking shoes, canteen, etc).
Emerald Bay
A moderately flat 6 mile hike round trip. This adventure allows the scouts to combine an ocean
war-canoe adventure with a hike along the scenic West End coast hills. Units will be assigned
by their commissioner either to hike to the beach and take a boat back, or to boat to the beach
and hike back. The boats are war canoes, in which all scouts and adult leaders will be on their
knees or bottoms in the canoe. The canoes do not have seats. The paddle takes approximately
20-30 mins. Campers should take their swimming gear, dry hiking boots, and water shoes. Plan
to enjoy the beautiful beach and waters of Emerald Bay. We do recommend bringing your snorkeling gear. This is a great hike for first year scouts, or those looking to enjoy a day in the water
and relaxing on the beach. *Goats Whiskers Loop may be added if a more difficult hike is preferred.*
Sailing in the wide blue
ocean.
Parson’s Landing
An approximate 8-mile round trip hike; along the scenic West End coast hills, to one of the more popular
west-end beaches. Campers should take their swimming gear, dry hiking boots, and water shoes. Plan to
enjoy the sandy beach and waters of Parson’s Landing. *Goats Whiskers Loop may be added if a more
difficult hike if a more difficult hike is preferred.*
Little Fisherman’s
“In Scouting, a boy is
encouraged to educate
himself instead of
being instructed”
Lord Baden Powell
An approximate five mile round trip hike up the Goat Whisker trail and down into Catalina Harbor. From Cat Harbor, you will hike around and past Two Harbors to Little Fisherman’s. Bring
your snorkel gear and experience sea life that the Pacific has to offer. Bring Frisbees or footballs for a fun day in and out of the water on the beach. Then change back into your hiking
clothes for the short 2 mile hike back to camp.
*Goat Whisker’s Loop
This hike adds approximately 2 miles round trip to either the Emerald Bay hike or the Parson's
Landing Hike. Campers will begin their hike day by summiting the peak that overlooks Cherry
Cove. At an altitude of 1224 feet, enjoy scenic views of Isthmus harbor, Cat Harbor, as well as
stunning views of the windward side of the island. Continue down the fire break road until you
meet the west end road and enjoy the remainder of your hike through the canyons of the West
End.
Page 13
Taking out the canoes.
Camp Cherry Valley
Leadership Training
Throughout the week, our senior staff will conduct Round Tables, which are open to all adult leaders.
Those adult leaders needing to certify or re-certify in Safe Swim Defense, and/or Safety Afloat can do so
upon request. Please contact the Camp Director or Program Director for this information.
Duty to God
The Boy Scouts of America is a Non-Denominational organization, which encourages each member to
actively participate in his religious beliefs and responsibilities. Our camp has a chaplain on duty and provides a chapel for individual scouts or groups. A Non-Denominational religious service is an optional part
of our Sunday evening program, and all are encouraged to attend. Grace or Prayers will be said before
each meal, and all campers will be given an opportunity to participate. Please let your Scouts know they
should feel free to pray as they have been taught, and remind them of the importance of showing respect
for all forms and traditions of prayer.
Advancement at Camp
The primary responsibility for rank advancement is that of the unit leaders and the unit committee. Our
camp staff will assist Unit leadership by providing the finest in instruction and counseling. Although staff
instructors and counselors will provide accurate records for information covered and skill accomplished, it
is the responsibility of each unit leader to mark rank advancements in each boy’s individual record
(usually in his handbook). Camp counselors will also sign merit badge cards, but the Unit is responsible
to ensure they are properly recorded in each boy’s permanent record.
Cherry Valley
Leaders Guide
Canoes
COUNCIL’S ADVANCEMENT POLICIES
1.
All advancement will be in accordance with BSA National Standards.
2.
Merit badge counselors must be supervised 18 years of age or older.
3.
No substitutions for any requirements will be allowed.
4.
Blue card for completed merit badges will be provided by camp staff.
5.
Those not completing all requirements for a specific merit badge will be given partial completion
slips.
6.
Boards of Review may be conducted in camp if adequate adult leadership is available. Appropriate adult representation on the board, however, is the responsibility of each Unit.
7.
The Scoutmaster, Coach, or Skipper, is responsible for preparing, monitoring, and verifying completion of the Scout’s advancement.
8.
Scouts are encouraged to prepare for each merit badge they plan to work on at camp. Work done
before camp is encouraged.
9.
Any Scout receiving a merit badge from our camps will know the subject matter and have learned
the practical skills associated with the merit badge.
NOTE: Unit leaders are given an opportunity to review all advancement records before leaving
camp and are encouraged to review them at home and give the cards to the Unit Advancement
Chairman.
Page 14
Advancement at Camp Cont.
Merit Badges are at the core of learning new skills at camp. In keeping with Scouting's great traditions,
merit badge classes are taught by passionate, knowledgeable staff. Merit badge requirements are taught to
the letter and scouts will receive their merit badge applications (blue cards) at the end of the week.
Some of the merit badges offered at our camps cannot be completed while at camp without some work
prior to arriving. Those merit badges are marked on the next page. Scoutmasters should advise each
scout, who plans to take such specified merit badges, to complete those requirements prior to arriving at
camp. Partial Merit Badges will be awarded at the end of the week for those who do not pass off all of the
requirements.
Unlike some other summer camps, Camp Cherry Valley does not focus solely on the completion of Merit
Badges. We believe Merit badges serve to enhance the scout camp experience. We recommend that
Scoutmasters and Adult Leaders encourage scouts to accomplish 3 merit badges each. This will ensure
they have time to complete the badges they are working on and allow them ample time to participate in
other activities.
Out in the wide open ocean
having fun!
When a scout signs up for the Handicraft class, he will have the opportunity to earn the Basketry, Leatherwork, Art, and Woodcarving merit badges during the week. These classes require a scout to purchase
supplies in the Trading Post. If a scout only wishes to earn one of these, it is recommended he come to the
Handicraft area during free time to earn it. Handicraft badges are very hands-on and allow a scout to go at
his own pace, but will likely require a scout to work on projects outside of merit badge and free time.
Some merit badges are more difficult than others. We suggest that only boys 14 and older sign up for
these classes. They have been marked on the next page.
One of the most popular merit badges at Camp Cherry Valley is Small-Boat Sailing. The sailing on Catalina Island is truly wonderful with predictable winds and manageable swells. However, our sailing resources are limited. We require that scouts who wish to take the merit badge class, be at least 14 years old
and have at least one other boating merit badge. This ensures that the scouts who take the merit badge
class are mentally and physically prepared to meet the challenges and reap the rewards that sailing has to
offer. Due to the high volume of material learned, the class is taught over the 2 nd and 3rd merit badge
hours.
“Merit badges are at
the core of learning
new skills at camp!”
Sailing, however, is for everybody! During free time all are welcome to come to the Waterfront and get
on a sailboat. Our knowledgeable sailing instructors will take groups of scouts out of the cove and into the
bay to teach and demonstrate basic sailing techniques. We have five, 14-foot monohull Lido boats and
two, 16-foot Hobie Catamarans. ACE participants, earning the ACE patch, must sail on the Catamarans
sometime during the week.
It is wise to look for merit badges that are not normally offered in your hometown and sign up for those
while at camp. Try new things and look for variety! Proper planning between the Scout, their adult leader,
and parents offers great support. Read the merit badge book before coming to camp. There is too much fun
going on at camp to spend time reading merit badge books!

We will NOT be doing online merit badge sign ups this year.
Please complete the form in the guide and bring it with you to
camp to be turned in with medical forms and permission slips.
Waterfront supplies
Page 15
Camp Cherry Valley
Merit Badges Offered
*OFFERED AT CLASS TIME AND FREE TIME
**CANNOT BE COMPLETED WITHOUT PREREQUISITES BEING DONE PRIOR TO
COMING TO CAMP
 SUGGESTED FOR SCOUTS 14 AND OLDER
$$ means there is cost for a kit or materials (buy at trading post or scout shop before coming to
camp)
PREREQUISITES
MERIT BADGE
MERIT
BADGES:
cannot be completed in
camp without prerequisites being completed
ARCHERY
PREREQUISITES
MERIT BADGE
MAMMAL STUDY*
ART*/**
4
OCEANOGRAPHY
ASTRONOMY*/**
6
ORIENTEERING*
BASKETRY*
$$ of kits
PERSONAL
FITNESS*
CANOEING
EMERGENCY
PREPAREDNESS*/**
cannot be completed in
camp without prerequisites being completed
6,7&8
PIONEERING*
1, 2C, 6C, 8A-C, 9B
ENVIRONMENTAL
SCIENCE*
RIFLE SHOOTING 
ROWING
$$ Must sign at least up
1 month before
FIRST AID
Cherry Valley
Leaders Guide
FISHING*/**
SCUBA DIVING
9/CAN NOT COOK
FISH AT CAMP
SOIL AND WATER
CONSERVATION*/**
GEOLOGY*
SWIMMING
$$ of kits
LEATHERWORK*
LIFESAVING
Page 16
7
WEATHER*
WILDERNESS SURVIVIAL 
KAYAKING
Many to chose from…..
SMALL BOAT SAILING 
FORESTRY*
INDIAN LORE*
MUST COMPLETE
SIGN UP FORM IN
GUIDE
$$ of kits
WOODCARVING*
$$
Trail to First Class Policies
Camp Cherry Valley is the perfect camp for scouts of all ages and the Trail to First Class program is designed with the newest scouts in mind. The class is offered during each merit badge period and during
free time. Scouts who sign up for the class during merit badge time ,will work with the camp instructors
to pass off requirements for the Tenderfoot, Second Class, and First Class rank. Scouts needing a few
specific requirements passed off can attend during any free time to pass them off. At the end of the week,
the instructors will fill out and submit to the scoutmaster a checklist of requirements passed off by each
individual boy. It is then up to the Scoutmaster to sign off the requirements in the boys' Scout Handbooks.
Trail to First Class Schedule
Monday- “Helmsman”
CCV Trail to First Class
Pass off most requirements dealing with compass
use. Knots will be started and the rules of safe hiking will be covered.
Monday
Requirement
Tenderfoot
4a, 4b, 4c, 5, 9
Tuesday- “Rambo”
2nd Class
1a
Knot tying will be completed. Scouts will cover
Leave No Trace Principles, then move on to safe
handling of knives, axes, and saws. Scouts will also
go over requirements dealing with cooking fires and
meal preparation.
1st Class
1, 7a, 7b, 8a
Tuesday
2nd Class
st
1 Class
2, 3c, 3d, 3e
4a, 4c, 4d
Thursday- “Fire Marshall Bill”
Thursday
On this day, scouts will go over all requirements
related to First Aid. They will learn fundamentals
in CPR and emergency situations.
Tenderfoot
12a, 12b
2nd Class
7a, 7b, 7c
Friday- “Baywatch”
1st Class
8b, 8c, 8d
Scouts will meet at the Waterfront to learn the principles of water safety. Safe swim defense and water
rescues will also be taught and practiced.
Friday
2nd Class
8a, 8b, 8c
Free Time-
1st Class
9a, 9b, 9c
Scouts can meet any time during free time to pass
off any requirement taught during class– with the
exception being Friday, when they will meet at the
beach during free time. Special free time for Trail
to First Class activities include the mile-long orienteering course, instruction in Tote'n Chip, and the
Firem'n Chit.
Free Time
Page 17
First Class rank
1st Class
Firem'n Chit
Tote'n Chip
2
The open-air is the
real objective of
Scouting and the key
to its success.
Lord Baden Powell
Camp Cherry Valley
Additional Programs
Swimming
Camp Cherry Valley has the most premiere swimming areas on the entire West Coast! The Waterfront is
operated in strict accordance with the BSA policies and is used for general swims during free time, merit
badge classes, and rank advancement instruction. If you have scouts that are beginners or non-swimmers,
they will have the opportunity, during free time, to work with our waterfront staff to pass their swim
check. It is the goal of the camp director and waterfront director for every scout at Camp Cherry Valley to
pass their swim check.
Swimming!
To pass the BSA Swim Check you must jump feet first into water over the head in depth. Level off and
swim 75 yards in a strong manner using one or more of the following strokes: sidestroke, breaststroke,
trudgen, or crawl; then swim 25 yards using an easy, resting backstroke. The 100 yards must be completed in one swim without stops and must include at least one sharp turn. After completing the swim,
scouts rest by floating.
Boating
Cherry Valley provides sailboats, canoes, rowboats, and ocean kayaks. These are available for use during
free time sessions on Tuesday, Thursday and Friday afternoons. CCV also offers sailing opportunities on
sailboats or catamarans each afternoon. Come on down and enjoy! This is a great opportunity for Scouts
and leaders to practice their boating skills or just have fun. Certified swimmers may use the canoes and
kayaks. Everyone must use a PFD. An orientation and demonstration of ability is required to use equipment. Please remember that all persons in the water are responsible for their actions and care must be
taken around the anchored yachts in Cherry Cove. The sailing merit badge will take up two merit
badge class times, so plan accordingly.
“Come on in, the
water’s fine”
Nature Area and Trail
Camp Cherry Valley area offers many opportunities to discover and learn about our environment and
Catalina Island’s unique plants and animals. We offer a nature trail, which is set up to be staff-led or selfguided.
Eagle’s Nest Snorkel
Each afternoon the staff provides a guided excursion to Eagle’s Nest. Snorkeling equipment is available to
check out, or you may bring your own. Along the coastline, you will have the opportunity to snorkel,
under careful supervision, in kelp forests, along the edge of the cliffs, and along an open channel which
team with fish and other wildlife.
Rifle and Archery Ranges
Rifle and archery ranges are available for use. All participants must receive a safety orientation and skill
training. Ammunition and arrows are provided at the range. In order to use the ranges, leaders must have
signed permission slips from the parent of the Scouts (See attached document at the back of this guide).
Shooting archery
Page 18
Fishing Program
Camp Cherry Valley is a great place to fish the clear waters of the San Pedro Channel. We practice the
catch-and-release method of fishing and require Scouts to do so also. CCV does not have facilities to
clean and prepare fish for eating and County prohibits us from cooking game fish in our kitchen. Anyone
wishing to fish, and who is 16 years or older, will need to have a current California fishing license. We
are able to issue poles and tackle on a limited basis. In order to have a successful fishing adventure at
camp, it is advised that you bring your own equipment. We also require that you use barb-less hooks for
easy release of the fish that you catch. Artificial tackle will be sold in the trading post.
Mile Swim
Off the dock
This is an individual activity. Participants will need another Troop member to supervise and count laps.
The BSA Mile Swim Award is a progressive award. Scouts or adult leaders can earn the BSA Mile Swim.
To do so they must pass the swim check and swim the ¼ mile, ½ mile and full mile during the week at
camp. They can complete these swims during afternoon free-time on Tuesday, Thursday and Friday. The
free-time period is from 2-5pm. Swimmers wishing to complete the BSA Mile Swim Award are encouraged to meet with the Waterfront Director at the beginning of free-time on Tuesday to get started.
BSA Lifeguard
This program is for older Scouts (14 and up) and adults. It will take approx. 40 hours to complete during
the week and will require the person to miss most of the free time activities and merit badge opportunities.
The candidates will participate, with our trained Waterfront Staff, throughout the week in all aspects of our
waterfront operation. If interested, please contact the Waterfront Director.
Special Opportunities
The following are special opportunities for boys to improve their skills and serve others. To have a chance
to earn special recognition in these fields you must meet the requirements written next to the award.
Those who participate and complete the requirements will be recognized at the end of camp and be eligible
to purchase the patch or carry the BSA certification card.
Firem’n Chit-Taught in the Handiland or Trail to First Class area during the free-time and is available to all adults and boys.
BSA Lifeguard- See BSA Lifeguard requirements above.
Snorkeling BSA- Taught by the ACE program and is available to all adults or boys 14 years or older.
Mile Swim BSA- Available to all Scouts. See Mile Swim requirements above.
Totin’ Chip- Taught in the Handiland or Trail to First Class area during the free-time and is available
to all adults and boys. Scouts must have this certification before they can handle knifes at camp.
Kayaking BSA- Taught by the ACE program and is available to all adults or boys 14 years or older.
Page 19
Camp Cherry Valley
Scuba
Camp Cherry Valley offers an introductory dive program for youth and adult campers as well as a
full PADI Scuba Certification and Scuba Diving Merit Badge.
You will find the reservation form at the end of this guide.
The PADI Discover Scuba Diving Program allows any camper 14 years and older the opportunity to
experience scuba diving and provides one, 20-30 minute ocean dive. This is a program that requires 4
hours of the campers’ time throughout the week. Participants will spend time in class reviewing key terms
and diving procedures, as well as developing their Scuba skills, by diving in the confined waters of Cherry
Cove and the surrounding open water. The cost for this program is an additional $135.00 and all gear
needed to participate is provided. It is recommended that scouts sign up through the camping department
at least 30 days before their arrival to camp and make payment to the council. However, scouts and adult
leaders can sign up and pay while at camp. If the scout’s parent/guardian is not present at camp, then the
forms will have to be completed and faxed or emailed to the camp before the scout can participate. Payment must also be made to the program office before the scout or adult will be allowed to dive.
The Scuba Diving Merit Badge is available to scouts 14 years and older who have passed their swim
check. If your scout is already Scuba Certified, they can sign up for the Scuba Diving Merit Badge Upgrade. This program is $135.00 and includes the requirements for the Scuba Diving Merit Badge along
with a guided dive. This program takes about 2 hours with a 20-30 minute dive included.
“To catch the reader's
attention, place an
interesting sentence or
quote from the story
here.”
If the scout is not Scuba Certified, he can sign up for a weeklong course during the merit badge periods in
which he will become PADI Certified and also go through the requirements for the Scuba Diving merit
badge. The cost for the PADI Scuba Certification and Scuba Diving Merit Badge Program is $325.00.
Scouts must also take the PADI eLearning Course online in order to become scuba certified. The cost of
the course is $120. Scouts should plan on giving themselves 1-2 months to complete the course work before they arrive at camp. Scouts must be able to complete the requirements for the merit badge. Paying
the course fee does not guarantee the scout will earn the merit badge.
Scouts and adult leaders who are already certified and wish to do a guided dive can sign up and pay at
camp.
The Guided Dive for Certified Divers costs $75. This includes all of your gear and oxygen for a 30-45
min dive in the cove. If you have a large group of divers we do recommend you call or email the council
office 2 weeks before you arrive to camp so that we can facilitate your group of divers.
Ready to dive
Catalina, being part of the Channel Islands, is one of the top 10 dive destinations in the world! The giant
kelp forests are a habitat for an abundance of marine life, including bright orange Garibaldi (the California
state marine fish), giant black sea bass (a protected species), California spiny lobster, and playful California sea lions – just to name a few.
Two Harbors Dive and Recreation Center is a full service PADI dive shop located in Two Harbors, just
two coves east of Camp Cherry Valley. They have an outstanding dive instruction team and top-of-the
line equipment to assist you in your adventure. We will have a satellite dive center set up at Camp Cherry
Valley to support all the camp’s diving instruction and activities.
Page 20
Please complete the forms at the back of this guide and bring them to camp with you.
Advanced Camper Experience Program (ACE)
Catamaran
During each summer camp session, we offer a program geared toward the older Scout (14 years and
older). The Advance Camper Experience (ACE) Program gives returning Scouts an opportunity to meet
others their own age, go on high adventure activities, and experience activities they may have never done
before. These scouts will stay in Troop campsites, eat, and participate in most Troop program activities
and all camp wide activities. The ACE Program can take the place of merit badge classes. Those campers
who participate in every ACE activity will receive a special recognition at the end of the camping week.
Scouts and Adult Leaders can earn the BSA Kayak and BSA Snorkel Awards by participating in the ACE
morning program activities
.
Activities include:
1. Kayaking on the open ocean
2. 16 Mile Shark Harbor Hike
3. Ship Rock snorkeling
4. Blue Cavern snorkeling
5. Catamaran Sailing
6. Stand Up Paddle Boarding
7. Goat Whiskers hike.
8. Pirate’s Cove Snorkel
Prerequisites are:
“Will you be joining
the ACE program?
Can you ACE it?”
1. 14 years of age by the first day of the program
2. Pass the camp swim test
3. Have a signed, current medical form on file in camp
4. Unit leader permission
ACE Week at a Glance
Time
Monday
Tuesday
9:15 am
Swim Checks assigned as troops
Ship Rock
Kayak/Snorkel
Wednesday
Breakfast:
6:00 AM
Shark Harbor Hike
Thursday
Blue Caverns
Snorkeling
Friday
Goat
Whiskers
Hike
Hike Day
BSA Snorkel
2:10 pm
Pack Check
Requirements
Pirate’s Cove
Stand-Up Paddle
Snorkel
Boarding/
Catamaran Sailing
Page 21
Catamaran
Sailing /
Catamaran
Sailing /
Stand-up
Stand-up
Paddle
Paddle
Boarding
Boarding
Snorkeling
Camp Cherry Valley 2013
Scuba Diving Programs
DO YOU WANT TO SCUBA DIVE ON CATALINA ISLAND?
The San Gabriel Valley Council, Boy Scouts of America has partnered with Two Harbors Dive & Recreation
Center to offer you the underwater world. Camp Cherry Valley on Catalina Island is now offering you the opportunity to participate in a variety of scuba programs. Minimum age for these programs is 14 years old.
All reservations must be done prior to coming to camp with the exception of the Guided Dive for Certified Divers.
*The PADI Discover Scuba Diving program:
 Available for an additional fee of $100.00.
(after summer camp fee)
 Scouts 14 and older/ Adults
 One dive under the direct supervision of a PADI
instructor.
 Program takes about 4 hours.
 Not a certification course, but can count toward
certification.
 The actual dive is about 20-30 minutes long.
 All equipment is included you just need your
swimsuit.
*Scuba Diving Merit Badge
(uncertified)
 Scouts 14 and older who have passed swim check
 Become PADI certified
 All requirements will be taught
 An open water dive
 Must take the PADI eLearning Course online
to be certified. Cost is an additional $138.00
paid online.
Guided Dive for Certified Divers:
 Available for an additional fee of $80.00. (after
summer camp fee)
 Scouts 14 and older/ Adults
 Includes gear and oxygen for a 30-45 minute dive
in the cove.
*Scuba Diving Merit Badge Upgrade
(already certified)
 Scouts 14 and older who have passed swim check
 All requirements will be taught
 2 hour program with a 20-30 minute with an open
water dive
Page 22
Camp Cherry Valley 2013
Scuba Diving Programs
So, don’t miss out on a chance to experience Catalina Island from below the waterline. All registration MUST be done prior to arriving at camp for all programs with *. Please complete the scuba forms at the back of this guide and take them to camp with you.
PADI Discover Scuba for Uncertified Divers
# of persons:
$100 per person
Total: $
PADI Discover Scuba for Certified Divers
# of persons:
$80 per person
Total: $
Scuba Diving Merit Badge Uncertified Scout
# of Scouts:
$350 per Scout
Total: $
*Scuba Diving Merit Badge Upgrade Certified Scout
# of Scouts:
$100 per Scout
Total: $
Names and Date Of Birth
Names and Date Of Birth
PADI Discover Scuba
(uncertified)
Upgrade (already certified)
Guided Dive for Certified Divers:
Council
Troop #
Week
Date of camp session
Contact Person Name
Address
City
State
Zip
Home Phone (______)
Email:
$
Total Due
Payment Method: __Cash __ Check __Visa __MasterCard __ American Express __ Discover
Credit Card Number
Exp. Date ____/_____
Cardholder Name:
Cardholder Signature:
CANCELLATION POLICY: UP UNTIL TWO WEEKS PRIOR TO CAMP, CANCELLATION FEE OF 25% OF TOTAL COST, AFTER THAT, NO REFUNDS CAN BE GIVEN.
Mail or bring form and payment to: San Gabriel Valley Council, B.S.A.,
3450 East Sierra Madre Blvd., Pasadena, CA 91107; Fax 626-351-9149 GL#711
Page 23
2013 CAMP CHERRY VALLEY WEEK AT A GLANCE
2013
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
Trading Post
Hours
7:00 AM
Starboard Watch
Breakfast
Port Inspection
7:00 AM
Starboard Watch
Breakfast
Port Inspection
7:00 AM
Starboard Watch
Breakfast
Flag Ceremony
7:00 AM
Starboard Watch
Breakfast
Port Inspection
7:00 AM
Starboard Watch
Breakfast
Port Inspection
7:00 AM
Starboard Watch
Breakfast & Port
Final Inspection
7:40 AM
Port Watch Breakfast
Starboard Inspection
7:40 AM
7:40 AM
7:40 AM
7:40 AM
7:40 AM
& Starboard Final
Inspection
8:45 AM
Flag Ceremony
8:45 AM
Flag Ceremony
8:45 AM
Flag Ceremony
8:45 AM
Flag Ceremony
8:30 AM
Closing Flag
Ceremony
Tribe of Torqua
9:15 AM
Starboard Watch
Swim Checks;
Port Free Time
9:25 AM
1st Merit Badge
Session
9:25 AM
1st Merit Badge
Session
9:25 AM
1st Merit Badge
Session
9:15 PM
Hike to Two
Harbors
10:15 AM
Scoutmaster
Roundtable
10:15 AM
Scoutmaster
Roundtable
10:15 AM
Scoutmaster
Roundtable
10:25 AM
2nd Merit Badge
Session
10:25 AM
2nd Merit Badge
Session
10:25 AM
2nd Merit Badge
Session
9:15 AM
Port Watch
Swim Check
Starboard Free Time
11:25 AM
3rd Merit Badge
Session
11:25 AM
3rd Merit Badge
Session
11:25 AM
3rd Merit Badge
Session
1:30 PM
Check in at Long
Beach
12:20 PM
Starboard Watch
Lunch
12:20 PM
Starboard Watch Lunch
2:30 PM
Depart Long Beach
1:00 PM
Port Watch Lunch
1:00 PM
Port Watch Lunch
Monday, Tuesday, Thursday,
Friday:
9 AM-7 PM
Wednesday:
3 -7 PM
Saturday:
7 – 9:30 AM
Morning Joe Coffee
6 – 8 AM
High Adventure Day
Lunch on the Trail
10:45 AM
Boat Departs Two
Harbors
12:20 PM
12:20 PM
Starboard Watch Lunch Starboard Watch Lunch
1:00 PM
Port Watch Lunch
1:00 PM
Port Watch Lunch
12:45- 1:15 PM
Boat arrives in Long
Beach
2:00 PM
1st Merit Badge
Session
4:30 PM
Arrive in Two Harbors;
Hike-in & Orientation
3:00 PM
2nd Merit Badge
Session
3:00 PM
Scoutmaster
Roundtable
2:00 - 5:00 PM
2:00 - 5:00 PM
Free time
Free time
All program areas open All program areas open
4:00 Scoutmaster Shoot
Troop Shoots
2:00 - 5:00 PM
Free time
All program areas open
4:00 PM
3rd Merit Badge
Session
6:00 PM
Starboard Watch
Dinner
5:15 PM
Starboard Watch
Dinner
5:15 PM
Starboard Watch
Dinner
5:15 PM
Starboard Watch
Dinner
5:15 PM
Starboard Watch
Dinner
5:15 PM
Starboard Watch
Dinner
6:45 PM
Port Watch Dinner
5:55 PM
Port Watch Dinner
5:55 PM
Port Watch Dinner
5:55 PM
Port Watch Dinner
5:55 PM
Port Watch Dinner
5:55 PM
Port Watch Dinner
7:30 PM
Scouts Own @ Chapel
7:00 PM
Commissioners
Team Building
Games
6:45 PM
Troop Friend Night
War Canoeing
7:30 PM
Flag Ceremony &
Commissioner Campfires
6:45 PM
Flag Ceremony and
Highland Relay
7:30 PM
Flag Ceremony and
Closing Campfire
8:00 PM
Flag Ceremony
Tribe of Torqua
SPL Ceremony
8:00 PM
Flag Ceremony
OA Speech
Opening Campfire
8:00 PM
Honor Trail
Waiter's call is 15 minutes before each meal. Please send 1 waiter for every table.
Port Watch Kybo duty after breakfast @ 8:00 AM. Starboard Kybo duty after dinner @ 5:45 PM.
Page 24
** On Saturday all luggage & gear needs to be at the loading dock before breakfast.
2013 CAMP CHERRY VALLEY– MERIT BADGE SIGN-UP SHEET
 Scouts 14 and older /
*offered at class time and free time / **cannot be completed in camp without prerequisites being completed
Note: Please only sign up for 3 classes per boy. Other badges can be taken during free time and are arranged with class instructor.
BSA LIFEGUARD
TRAIL TO FIRST CLASS
WOODCARVING *
WILDERNESS SURVIVIAL 
WEATHER *
SWIMMING
SOIL AND WATER CONSERVATION */**
SMALL BOAT SALILING  (COUNTS AS 2 MB PERIODS & 14 AND OLDER)
ROWING
RIFLE SHOOTING 
PIONEERING *
PERSONAL FITNESS *
ORIENTEERING *
OCEANOGRAPHY
MAMMALS STUDY *
LIFESAVING
LEATHERWORK * $$
INDIAN LORE *
KAYAKING
GEOLOGY *
FORESTRY *
FISHING */**
FIRST AID
ENVIRONMENTAL SCIENCE *
EMERGENCY PREPAREDNESS */**
CANOEING
BASKETRY * $$
ASTRONOMY */**
ART */**
SCOUTS NAME:
TROOP#
________
Page 25
_________
WEEK#
ARCHERY
Camp Cherry Valley
SAN GABRIEL VALLEY COUNCIL
BOY SCOUTS OF AMERICA
At the council’s camps, the children have the opportunity to participate in the activities
listed below. However, to participate, they must have the consent of their parent or
guardian. Please indicate with a check mark, those activities which will apply to your
child and the camp he/she is attending, sign and date the form and send it to camp with
your child.
Troop #:
I give consent for ___________________________________, who is my son or ward, to
use the following equipment:
At Camp Cherry Valley

Archery

BB’s

.22 Rifles
_______________________________________________________________
Parent/Guardian Signature
Print parent/guardian name
Page 26
Date
2013 Camp Cherry Valley Unit Overnight
TRASK SCOUT CAMP, MONROVIA CANYON
Sleep under the stars; enjoy swimming, dinner and breakfast before you leave for your Cherry Valley
adventure! Additionally, we are now offering an optional sack lunch to take with you to the boat.
Some troops stay there at both ends of the week! We will send directions to Camp Trask with confirmation of your reservation.
Troop Number
Arrival Date
Council:
Leader Name
Estimated arrival time
Address
City/St/Zip
Daytime Telephone:
Number of people
Email:
$20.00 per person X # of people $
(includes dinner and breakfast)
$5.00 per person for sack lunch X # of people $
$
Payment method Check
Cash
VISA
Total enclosed
MasterCard
American Express
Credit Card Number
Discover
Exp. Date
Cardholder Signature
*Return as soon as possible to reserve your space!
There are a limited number of two person platform tents available. These tents will be assigned on a first come first serve
bases. Please come prepared to sleep under the stars, you will need ground cover.
#1-6701-751-21
Page 27
Annual Health and Medical Record
Registro Médico y de Salud Anual
(Valid for 12 calendar months)
(Válido por 12 meses calendario)
Policy on Use of the Annual Health
and Medical Record
Política para el uso del Registro Médico
y de Salud Anual
In 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 provider—a
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.
A fin de proporcionar una mejor atención para sus miembros
y para ayudarles a entender mejor sus propias capacidades
físicas, Boy Scouts of America recomienda que todos aquellos
que participen en un evento Scouting se sometan a un examen
médico anual realizado por un prestador de servicios de salud
certificado y con licencia: un médico (Doctor en medicina o
Doctor en osteopatía), enfermera profesional o asistente médico.
Proporcionar su información médica en este formulario de cuatro
partes, ayudará a asegurar que usted cumple con los estándares
mínimos de participación en varias actividades. Tome en cuenta
que los líderes de unidad siempre deben proteger la privacidad
de los participantes al salvaguardar su información médica.
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 heathcare provider—physician (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 highadventure 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.
• 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.
• Northern Tier National High Adventure Base.
• Florida National High Adventure Sea Base. The PADI medical
form is also required if scuba diving at this base.
• Summit Bechtel Reserve.
Las Partes A y B las deben completar, por lo menos una vez
al año, los participantes de todos los eventos Scouting. Este
historial médico, notificación de consentimiento y convenio de
exoneración de responsabilidad por parte de los padres/tutores,
y formulario de cesión 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 físico 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 descripción. La Parte
C la debe completar y firmar un prestador de servicios de salud
certificado y con licencia: un médico (Doctor en medicina o
Doctor en osteopatía), enfermera profesional o asistente médico.
Es importante tomar en cuenta que los límites de estatura y peso
deben ser estrictamente controlados cuando el evento llevará a
la unidad a más de 30 minutos de un vehículo de emergencia,
camino accesible, o cuando el programa lo requiera, tal como
expediciones, actividades de aventura extrema y proyectos
de conservación en áreas 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, así 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.
• Rancho Scout Philmont. Los participantes e invitados en las
actividades Philmont que se realicen con acceso limitado a las
zonas campestres, incluyendo la mayoría de las conferencias
y programas familiares en el Centro de Capacitación Philmont,
no requerirán llenar la Parte C. Sin embargo, los participantes
deberán repasar la Parte D para entender los riesgos
potenciales inherentes a los 6,700 pies de elevación en un
ambiente seco del Suroeste. Favor de revisar la información
de registro específica para la actividad o evento.
• Base nacional de aventura extrema Northern Tier.
• Base nacional marina de aventura extrema de la Florida.
También se requiere el formulario médico PADI si se va a
bucear en esta base.
• Summit Bechtel Reserve.
Risk Factors
Based 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.
• Excessive body weight
• Heart disease
• Hypertension (high blood
pressure)
• Diabetes
• Seizures
• Lack of appropriate
immunizations
• Asthma
• Allergies/anaphylaxis
• Muscular/skeletal
injuries
• Psychiatric/
psychological and
emotional difficulties
Factores de riesgo
Con base en la gran experiencia de la comunidad médica, BSA
ha identificado los siguientes factores de riesgo que podrían
limitar su participación en varias aventuras al aire libre.
• Peso corporal excesivo
• Enfermedad cardiaca
• Hipertensión (Presión
arterial alta)
• Diabetes
• Convulsiones
• Falta de vacunación
adecuada
• Asma
• Alergias/anafilaxia
• Lesiones musculares/
óseas
• Trastornos psiquiátricos/
psicológicos y
emocionales
For more information on medical risk factors, visit Scouting
Safely on www.scouting.org.
Para obtener más información sobre los factores de riesgo
médicos, visite Scouting Safely en www.scouting.org.
Prescriptions
The taking of prescription medication is the responsibility of the
individual taking the medication and/or that individual’s 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.
Prescripciones
Tomar los medicamentos prescritos es responsabilidad del
individuo que requiere el medicamento o del padre de familia
o tutor del individuo. Un líder, después de haber obtenido toda
la información necesaria, puede aceptar la responsabilidad de
asegurarse de que un niño tome el medicamento necesario a la
hora apropiada, pero BSA no obliga ni necesariamente anima
al líder a que lo haga. Asimismo, si las leyes estatales son más
limitantes, deben ser cumplidas.
Frequently Asked Questions (FAQs)
• Philmont Scout Ranch: www.philmontscoutranch.org or
575-376-2281
• Northern Tier National High Adventure Program:
www.ntier.org or 218-365-4811
• Florida National High Adventure Sea Base:
www.bsaseabase.org or 305-664-5612
• National Scout jamboree: www.bsajamboree.org
• Summit Bechtel Reserve: www.summitblog.org or
304-250-6750
For frequently asked questions about this Annual Health and
Medical Record, see Scouting Safely 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/.
Preguntas frecuentes
• Rancho Scout Philmont: www.philmontscoutranch.org
ó 575-376-2281
• Base nacional de aventura extrema Northern Tier:
www.ntier.org ó 218-365-4811
• Base nacional marina de aventura extrema de la Florida:
www.bsaseabase.org ó 305-664-5612
• Jamboree Scout Nacional: www.bsajamboree.org
• Summit Bechtel Reserve: www.summitblog.org
ó 304-250-6750
Para consultar las preguntas frecuentes sobre este Registro
Médico y de Salud Anual, consulte Scouting Safely en línea en
http://www.scouting.org/scoutsource/HealthandSafety.aspx. La
información sobre la Ley de responsabilidad y transferibilidad de
seguros médicos (HIPAA, por sus siglas en inglés) se encuentra
en www.hhs.gov/ocr/privacy/.
680-001
2012 Printing
Rev. 9/2012
Parte A Nombre completo
Fecha de nacimiento Alergias
Teléfono en caso de emergencia
Part A Full name:_________________________________DOB:________________ Allergies:___________________ Emergency contact No.:______________
Annual Health and Medical Record
Registro Médico y de Salud Anual
Part A/Parte A
High-adventure base participants:
Participantes en la base de aventura extrema:
Expedition/crew No.
Expedición/grupo no.:_______________________________
or staff position
o puesto fijo: ______________________________________
GENERAL INFORMATION/INFORMACIÓN GENERAL
Name ____________________________________________________ Date of birth ___________________________________ Age ____________ Nombre Fecha de nacimiento (MM/DD/Year) - (MM/DD/Año) Edad Male Masculino
Female
Femenino
Address ______________________________________________________________________________________________ Grade completed (youth only)______________________
Domicilio
Grado escolar completado (sólo niños)
City __________________________________________________________ State______________ Zip ______________________ Phone No. _______________________________
Ciudad Estado Código postal No. telefónico
Unit leader ____________________________________________________ Council name/No. ___________________________________________ Unit No. ___________________
Líder 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 médicas para brindar tratamiento) Preferencia religiosa
Health/accident insurance company ____________________________________________________________ Policy No. ________________________________________________
Compañía de seguro médico/accidental No. de póliza
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 MÉDICO, 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 _______________________________
Teléfono de casa Teléfono de oficina Teléfono móvil
Alternate contact name _____________________________________________________________________ Alternate’s phone ___________________________________________
Nombre de contacto alterno Teléfono del contacto alterno
HEALTH HISTORY/HISTORIAL MÉDICO
Please fill in the bubbles as indicated below:
Por favor rellene los círculos tal como se indica a continuación:
Do you currently have, or have you ever been treated for any of the following?
Incorrect:
¿Tiene actualmente, o ha tenido alguna vez los siguientes?
Yes/Sí
No/No
Incorrecto
Condition/Padecimiento
Asthma
Asma Diabetes
Diabetes Correct:
Correcto
Explain/Explique
Last attack: (MM/YY)
Último ataque: (MM/AA)
%
Last HbA1c: (Percentage)
Última HbA1c: (Porcentaje)
Hypertension (high blood pressure)
Hipertensión (presión alta)
Heart disease/heart attack/chest pain/heart murmur
Enfermedad del corazón/infarto/dolores de pecho/soplo cardíaco
Stroke/TIA
Apoplejía/Accidente isquémico transitorio
Lung/respiratory disease
Enfermedades pulmonares/respiratorias
Ear/sinus problems
Problemas del oído/senos paranasales
Muscular/skeletal condition
Condiciones musculares/óseas
Menstrual problems (women only)
Problemas menstruales (sólo mujeres)
Psychiatric/psychological and emotional difficulties
Dificultades psiquiátricas/psicológicas y emocionales
Behavioral/neurological disorders
Trastornos de conducta/neurológicos
Bleeding disorders
Enfermedades hemorrágicas
Fainting spells
Desmayos
Thyroid disease
Enfermedades de la tiroides
Kidney disease
Enfermedades del riñón
Sickle cell disease
Anemia falciforme
Seizures
Last seizure: (MM/YY)
Convulsiones Última convulsión: (MM/AA)
Sleep disorders (e.g., sleep apnea)
Trastornos del sueño (por ejemplo, síndrome de apnea-hipopnea durante el sueño)
Use CPAP: Usa CPAP
Yes
Sí
No
No
Abdominal/digestive problems
Problemas abdominales/digestivos
Surgery
Cirugía
Last surgery: (MM/YY)
Última cirugía: (MM/AA)
Serious injury
Lesión grave
Excessive fatigue or shortness of breath with exercise
Fatiga en exceso o dificultad para respirar al hacer ejercicio
Other
Otro
Page 1 of 2
PART A (continued on next page)
HEALTH HISTORY/HISTORIAL MÉDICO
Please fill in the bubbles as indicated:
Are you allergic to or do you have any adverse reaction to any of the following?
Por favor rellene los círculos tal como se indica:
¿Es alérgico a, o le causa alguna reacción adversa cualquiera de los siguientes?
Yes/Sí
Correct:
IncorrectoCorrecto
Explain
Allergies or Reaction to
No/No
Incorrect:
Alergias o Reacciones a
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 Tétanos es obligatoria y debe haberla recibido en los últimos 10 años. Por cada punto, indique si ha sido vacunado, la fecha
en que la recibió (MM/AA), si ha padecido la enfermedad, y la fecha (MM/AA).
Immunized?
Immunizations
¿Vacunado?
Yes/Sí
Date (MM/YY)
Fecha (MM/AA)
Vacunas
No/No
Had Disease?
Date (MM/YY)
¿La ha padecido?
Yes/Sí
Fecha (MM/AA)
No/No
Tetanus
Tétano
Pertussis
Part A Full name: __________________________________________________________ DOB: ____________________
Parte A Nombre completo Fecha de nacimiento
Tos ferina
Diphtheria
Difteria
Measles
Sarampión
Mumps
Paperas
Rubella
Rubéola
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).
Exención de vacunas solicitada (formulario obligatorio).
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 información sobre inhaladores y EpiPen, incluso si son sólo para uso ocasional o en caso de emergencia.
Medication Medicamento__________________________________________
Strength Frequency
Dosis _____________________ Frecuencia _________________
Strength Frequency
No medications
Sin medicamentos
Additional medications (sheet attached)
Medicamentos adicionales (hoja anexa)
Strength Frequency
Approximate date started Approximate date started Approximate date started Reason for medication
Reason for medication
______________________________________________________
______________________________________________________
______________________________________________________
Medication Medication Medication Fecha aproximada de inicio______________________________
Razón del medicamento_________________________________
Medicamento__________________________________________
Strength Frequency
Fecha aproximada de inicio______________________________
Medicamento__________________________________________
Strength Frequency
Medicamento__________________________________________
Strength Frequency
Approximate date started Approximate date started Approximate date started Reason for medication
______________________________________________________
______________________________________________________
______________________________________________________
Administration of the above medications
is approved by (if required by your state):__________________________________________________________/________________________________________________________
La administración de los medicamentos arriba
Parent/guardian signature
and/or
mencionados está aprobada por (si lo requiere su estado)
Firma del padre o tutor
y/o
MD/DO, NP, or PA signature
Firma del Dr., Enfermera
profesional, Asistente médico
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 ESTÉN
CADUCADOS, incluyendo inhaladores y EpiPens. NO DEBE DEJAR DE tomar cualquier medicamento de mantenimiento a menos
que se lo indique su médico.
Page 2 of 2
680-001
2012 Printing
Rev. 9/2012
Part B Full name: __________________________________________________________ DOB: ____________________
Parte B Nombre completo Fecha de nacimiento
Part B/Parte B
Expedition/crew No./Expedición/grupo no.: _______________________________
or staff position/o puesto fijo: ____________________________________________
Informed Consent and Release Agreement
NOTIFICACIÓN DE CONSENTIMIENTO Y EXONERACIÓN DE RESPONSABILIDAD
I 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.
Entiendo que la participación en actividades Scouting implica un cierto
grado de riesgo y que pueden ser física, mental y emocionalmente
agotadoras. Asimismo, entiendo que la participación en dichas actividades
es completamente voluntaria y requiere que los participantes se acaten a
las reglas y estándares de conducta pertinentes.
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 participant’s parents or guardian, and/or determination of the
participant’s ability to continue in the program activities.
En caso de que yo, o mi hijo, nos veamos involucrados en un caso de
emergencia, entiendo que se hará 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 médicos seleccionado por el
líder adulto a cargo para asegurar que se proporcione el tratamiento
adecuado, incluyendo hospitalización, anestesia, cirugía o inyecciones
de medicamentos para mí o mi hijo. Los proveedores médicos están
autorizados a compartir información médica protegida con el adulto
a cargo, el personal médico del campamento, la administración del
campamento, o cualquier médico o proveedor de servicios médicos
involucrado en la administración de atención médica al participante. La
Información médica protegida/Información médica confidencial (PHI/CHI,
por sus siglas en inglés) bajo los Estándares de privacidad de información
médica individualmente identificable, 45 C.F.R. §§160.103, 164.501, etc.,
y siguientes como se enmiendan de vez en cuando, incluye resultados
de reconocimientos médicos, resultados de pruebas y tratamiento
proporcionado para propósitos de evaluación médica del participante,
seguimiento y comunicación con los padres o tutor del participante,
y determinación de la habilidad del participante de continuar con las
actividades del programa.
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.
He considerado cuidadosamente el riesgo implicado y he dado el
consentimiento para mí mismo o mi hijo de participar en dichas
actividades. Apruebo que se comparta la información contenida en este
formulario con los voluntarios y profesionales de BSA que necesiten tener
conocimiento de condiciones médicas que puedan requerir consideración
especial para la realización 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 reclamación
o responsabilidad que surja a raíz de esta participación.
Without restrictions./Sin restricciones.
With special considerations or restrictions (list)/Con condiciones especiales o restricciones (lista):
________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________
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.
Por este conducto asigno y otorgo al concilio local y a Boy Scouts of
America el derecho y permiso para usar y publicar las fotografías/películas/
videocintas/representaciones electrónicas y grabaciones de sonido de mí
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 publicación.
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.
Por este conducto autorizo la reproducción, venta, derechos reservados,
exhibición, transmisión, almacenamiento electrónico y distribución de
dichas fotografías/películas/ videocintas/representaciones electrónicas
y grabaciones de sonido sin limitación a discreción de Boy Scouts
of America, y específicamente renuncio a cualquier derecho de
compensación alguna que pueda tener por cualquiera de lo anterior.
Yes/Sí
No/No
Page 1 of 2
PART B (continued on next page)
ADULTS AUTHORIZED TO TAKE YOUTH TO AND FROM EVENTS:
You must designate at least one adult. Please include a
telephone number.
ADULTOS AUTORIZADOS PARA TRANSPORTAR AL NIÑO HACIA Y DESDE
LOS EVENTOS:
Debe designar por lo menos a un adulto. Por favor incluya un número telefónico.
1. Name/Nombre___________________________________________________________________________Telephone/Teléfono _________________________
2. Name/Nombre___________________________________________________________________________Telephone/Teléfono_________________________
Adults NOT authorized to take youth to and from events/Adultos NO autorizados para transportar al niño hacia y desde los eventos:
1. Name/Nombre ___________________________________________________________________________Telephone/Teléfono_________________________
2. Name/Nombre ___________________________________________________________________________Telephone/Teléfono_________________________
Part B Full name: __________________________________________________________ DOB: ____________________
Parte B Nombre completo Fecha de nacimiento
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.
Entiendo que, si cualquier información que he/hemos proporcionado
es errónea, puede limitar o eliminar la oportunidad de participación en
cualquier evento o actividad.
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 healthcare provider. If the participant is under the age of 18, a parent
or guardian’s signature is required.
Si participo en Philmont, el Centro de Capacitación Philmont,
Northern Tier, la Base Marina de la Florida o Summit Bechtel Reserve:
También he leído 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 permitirá 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 específicamente
señaladas por mí o el proveedor de servicios médicos. Si el
participante es menor de 18 años, se requiere la firma de el padre/
madre o tutor.
Participant’s name/Nombre del participante______________________________________________________________________________________________
Date/Fecha
Participant’s signature/Firma del participante
Parent/guardian’s signature/Firma del padre o tutor
(if participant is under the age of 18/si el participante es menor de 18 años)
Second parent/guardian signature/Firma del otro padre o tutor
(if required; for example, CA/si se requiere; por ejemplo en CA)
Date/Fecha
Date/Fecha
This Annual Health and Medical Record is valid for 12 calendar months.
Este Registro Médico y de Salud Anual tiene vigencia por 12 meses calendario.
Page 2 of 2
680-001
2012 Printing
Rev. 9/2012
Part C/Parte C
Pre-participation Physical
Examen físico previo a la participación
Expedition/crew No.
Expedición/grupo no.:_______________________________
or staff position
o puesto fijo: ______________________________________
TO THE EXAMINING HEALTH CARE PROVIDER
PARA EL PROVEEDOR DE SERVICIOS DE SALUD QUE
REALICE EL RECONOCIMIENTO (Médicos certificados y
(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 unitbased or at one of the national high-adventure bases, please refer to
Part D for additional information.
Height (inches) Estatura (pulgadas)
Weight (pounds) Peso (libras)
Part C Full name: __________________________________________________________ DOB: ____________________
Parte C Nombre completo Fecha de nacimiento
Blood pressure Presión arterial
Pulso
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.
Examiner: Please fill in the information.
Examinador: Favor de completar la información.
Normal
Porcentaje de grasa corporal (opcional)
Yes/Sí
No/No
Si usted excede el peso máximo para su estatura tal como se explica
en la siguiente página y su actividad de aventura extrema planeada
le llevará a más de 30 minutos de distancia de una vía con acceso
para un vehículo de emergencia, usted no podrá participar. A juicio
de los consejeros médicos del evento o campamento, la participación
de un individuo que exceda el peso máximo 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 hidrostático o de densitometría ósea para
determinarlo). Por favor llame al líder del evento o del campamento si
tiene preguntas. El cumplimiento de los lineamientos de estatura y peso
se recomienda encarecidamente para todos los demás eventos.
Range of Mobility
Rango de movilidad
Eyes
Knees (both)
Ears
Ankles (both)
Nose
Spine
Ojos
Cumple con los límites
de estatura/peso
Percent body fat (optional)
Explique cualquier anomalía
Meets height/
weight limits
Máximo peso para la estatura
Abnormal Explain Any Abnormalities
Anormal
Maximum weight for height
Pulse Normal
licenciados, enfermeras profesionales y asistentes médicos)
Se les está solicitando que certifiquen que este individuo no tiene
contraindicación para participar en una experiencia Scouting tal como
se describe en la Parte D. Para individuos que estarán 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
información adicional.
Incorrect:
Correct:
IncorrectoCorrecto
Normal
Normal
Abnormal Explain Any Abnormalities
Anormal
Explique cualquier anomalía
Rodillas (ambas)
Oídos
Tobillos (ambos)
Nariz
Espina
Throat
Garganta
Lungs
Pulmones
Neurological
Other
Yes
Otro
Neurológico
Sí
Heart
Personal or family
history of heart disease
Abdomen
Medical equipment
(i.e., CPAP, oxygen)
Genitalia/hernia
Contacts
Skin
Dentures
Emotional
adjustment
Braces
Corazón
No
Explain
Explique
Historial personal o familiar
de enfermedad cardíaca
Abdomen
Equipo médico (por
ejemplo, CPAP, oxígeno)
Genitales/hernia
Lentes de contacto
Piel
Dentaduras
Tratamientos de
ortodoncia
Ajuste emocional
Tuberculosis (TB) skin test (if required by your state for BSA camp staff):
Negative/Negativo Prueba de Tuberculosis (TB) (si lo requiere su estado para personal del campamento BSA)
Allergies/Alergias:
No
No/No�
Positive/Positivo
Yes/Sí (explain to what agent, type of reaction, treatment/explique a qué agente, tipo de reacción, tratamiento):
___________________________________________________________________________________________________________________________________
Medical restrictions to participate/Restricciones médicas para participar:
No/No
Yes/Sí (explain/explique):
___________________________________________________________________________________________________________________________________
Page 1 of 2
PART C (continued on next page)
EXAMINER’S CERTIFICATION
CERTIFICACIÓN
DEL EXAMINADOR
Height
(inches)
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 médico, examinado a esta persona
y no encuentro contradicciones para su participación en una experiencia
Scouting. Este participante (con las restricciones descritas anteriormente):
TrueFalse
CiertoFalso
Part C Full name: __________________________________________________________ DOB: ____________________
Parte C Nombre completo Fecha de nacimiento
Incorrect:
Correct:
IncorrectoCorrecto
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
Excepción
permitida
Aceptación
máxima
65
114-162
163-195
195
Cumple con los requisitos de estatura/peso
66
118-167
168-201
201
oes not have uncontrolled heart disease,
D
asthma, or hypertension
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
No ha tenido una lesión ortopédica, problemas
musculoesqueléticos o cirugía ortopédica en los últimos
seis meses o posee una carta de autorización por parte
de su cirujano ortopédico o médico
Maximum
Acceptance
Meets height/weight requirements
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
Peso recomendado
(libras)
Allowable
Exception
No tiene cardiopatía, asma o hipertensión incontrolados
Estatura
(pulgadas)
Recommended
Weight (lbs)
Has no uncontrolled psychiatric disorders
73
144-205
206-246
246
Has had no seizures in the last year
74
148-210
211-252
252
Does not have poorly controlled diabetes
75
152-216
217-260
260
If less than 18 years of age and planning to
scuba dive, does not have diabetes, asthma,
or seizures
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
No tiene trastornos psiquiátricos incontrolados
No ha tenido convulsiones en el último año
No tiene diabetes mal controlada
Si tiene menos de 18 años 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
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 está basada en los Lineamientos dietéticos para estadounidenses del
Departamento de Agricultura de los EE.UU. y del Departamento de Salud y
Servicios Humanos.
Domicilio ____________________________________________________________
DO NOT WRITE IN THIS BOX
NO ESCRIBA EN ESTE RECUADRO
City, state, zip
Ciudad, estado, código postal _________________________________________
Office phone
REVIEW FOR CAMP OR SPECIAL ACTIVITY/REVISIÓN PARA CAMPAMENTO O
ACTIVIDAD ESPECIAL
Date
Reviewed by
Revisado por ______________________________________________________________
Teléfono del consultorio _______________________________________________
Fecha ______________________________________________________________
Examiner signature in the box below.
Firma del examinador en el recuadro de abajo.
Date
Fecha ____________________________________________________________________
Further approval required Se requiere aprobación adicional
Yes Sí
No
No
Reason
Razón_____________________________________________________________________
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 aquí para obtener más información sobre las excursiones de aventura extrema o visite www.scouting.org/filestore/HealthSafety/pdf/
part_d.pdf.
Page 2 of 2
680-001
2012 Printing
Rev. 9/2012
Part D: High-Adventure Notes to Physicians and
Parents
Parte D: Notas para médicos y padres de familia
sobre aventura extrema
Participation at any of the BSA’s 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:
La participación en cualquiera de las bases de aventura
extrema de BSA, o en cualquier actividad de aventura extrema
en terrenos campestres aislados puede ser física, 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:
• Fill in parts A and B of the Annual Health and Medical
Record.
• Share Part D with the examining health-care provider.
• Have a physical exam by a certified and licensed healthcare provider/physician (MD, DO), nurse practitioner, or
physician assistant, and have part C completed.
• Read the following information, which focuses on specific
risks at the high-adventure base you will be attending.
• Completar las partes A y B del Registro Médico y de Salud
Anual.
• Compartir la parte D con el proveedor de atención médica que
realizará el reconocimiento.
• Someterse a un examen físico por un proveedor de atención
médica/médico (MD, DO), enfermera profesional o asistente
médico certificado y licenciado y que éste complete la parte C.
• Leer la siguiente información que se enfoca en riesgos
específicos en la base de aventura extrema a la que acudirá.
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 30 to 90 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 crosscountry ski trek. Refer to the Philmont Scout Ranch website
for 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
3 miles, or more if on a cross-country ski trek. Refer to the
Northern Tier website for specific information.
Florida Sea Base. Climatic conditions at Florida Sea Base
include temperatures ranging from 50 to 95 degrees, high
humidity, 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. Refer to the Sea Base website for specific
information.
Experiencia en las caminatas. Cada base de aventura extrema
ofrece una experiencia única que implica riesgos. El personal
experto dará instrucciones a todos los participantes con respecto
a las medidas de seguridad que se deben seguir. Prepárese para
escuchar y seguir con atención dichas medidas y a aceptar la
responsabilidad por la salud y seguridad de usted y los demás.
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 día en un ambiente montañoso, silvestre y aislado
con una elevación entre 6,500 y 12,500 pies. Las condiciones
climatológicas del verano/otoño incluyen temperaturas de
los 30 a los 90 grados, poca humedad (10 a 30 por ciento) y
frecuentes, e incluso severas tormentas eléctricas por la tarde.
Las actividades incluyen montar a caballo, escalar en roca,
rapel, eventos desafiantes, treparse a un mástil, disparo con
pólvora, tiro al vuelo de calibre 12, tiro con cartucho .30-06,
senderismo, bicicleta de montaña y otras actividades que tienen
posibilidades de causar lesiones.
Las condiciones climáticas invernales pueden abarcar de -20 a
60 grados. Para la Aventura invernal, cada persona caminará,
esquiará o caminará con raquetas para nieve a lo largo de
senderos cubiertos de nieve jalando trineos de carga durante
tres millas de distancia o más en un sendero para esquí a campo
traviesa. Consulte el sitio web del Rancho Scout Philmont para
obtener información específica.
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 día en lugares escabrosos, pantanosos y rocosos y
remar de 10 a 15 millas por día, con frecuencia con viento de
frente.
Las condiciones climáticas pueden variar entre los 30 y 100
grados en el verano/otoño y de -40 a 40 grados en el invierno.
Para la Experiencia Okpik, cada persona caminará, esquiará
o caminará con raquetas para nieve a lo largo de senderos
cubiertos de nieve o a través de lagos congelados jalando
trineos de carga durante tres millas de distancia o más en un
sendero para esquí a campo traviesa. Consulte el sitio web de
Northern Tier para obtener información específica.
Base Marina de la Florida. Las condiciones climáticas en
la Base Marina de la Florida incluyen temperaturas que van
desde los 50 hasta los 95 grados, humedad elevada, e índice
de calor que alcanza los 110 grados y hay frecuentes e incluso
severas, tormentas eléctricas por la tarde. Las actividades
incluyen snorkel, buceo, kayak, canotaje, vela, excursión, y otras
actividades que pueden causar lesiones. Consulte el sitio web
de la Base Marina para obtener información específica.
Page 1 of 8
PART D (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 Summit Bechtel Reserve, you should be physically
fit, 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,
CPR, and accident prevention and are prepared to assist the
adult 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
first aid and CPR. Medical and search-and-rescue services
are 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. Philmont’s 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 Tier’s
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 Northern Tier. Radio communication and/
or 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 hincapié en las precauciones de
seguridad adecuadas. Ya que la mayoría de los participantes
están 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 Summit Bechtel Reserve, usted deberá estar en forma física,
tener 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 exposición a accidentes,
enfermedades o lesiones.
Los miembros del personal de aventura extrema han sido
capacitados en primeros auxilios, RCP y prevención de accidentes,
y están preparados para ayudar al asesor adulto a reconocer,
reaccionar y responder ante accidentes, lesiones y enfermedades
según sea necesario. Se requiere que cada grupo tenga por lo menos
un miembro capacitado en primeros auxilios en la naturaleza y RCP.
Los servicios médicos y de búsqueda y rescate son proporcionados
como respuesta ante un accidente o emergencia. Sin embargo, los
tiempos de respuesta pueden verse afectados por la ubicación,
el terreno, el tiempo, u otras emergencias y puede retrasarse por
horas o incluso días 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 mayoría de las conferencias y programas familiares
en el Centro de Capacitación Philmont, deberán repasar la Parte D
para entender los riesgos potenciales inherentes a los 6,700 pies
de elevación en un ambiente seco del Suroeste.
La gran altitud; un programa de aventura extrema físicamente
exigente en áreas montañosas remotas; acampar mientras se
está expuesto a condiciones climatológicas ocasionalmente
severas tales como relámpagos, granizo, inundaciones
repentinas, y calor; y otros problemas potenciales, incluyendo
lesiones a causa de tropezones y caídas, caídas de un caballo,
golpe de calor, y accidentes de vehículos a motor, pueden
empeorar condiciones médicas subyacentes. Los senderos de
Philmont son empinados y pedregosos. Los animales salvajes
tales como osos, víboras 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 (575-3762281) si tiene preguntas.
Northern Tier. Mientras participe en las áreas 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 vía radio y en lugares más
remotos por teléfono satelital, son proporcionadas por Northern
Tier. La comunicación por radio y la evacuación 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, natación,
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 respiración y ecualización
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 supervisión directa de un instructor calificado.
Page 2 of 8
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 10 years. Recognition
will 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 highadventure 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 50
7.Diabetes
8.Smoking
9. Excessive weight
Para bucear de manera segura, los participantes no deben
estar extremadamente pasados de peso o tener condición
física deficiente. Bucear puede ser extenuante bajo ciertas
condiciones. Los sistemas respiratorio y circulatorio de los
participantes deben estar en buena condición. Todos los
espacios de aire del cuerpo deben ser normales y estar
saludables. Una persona con problemas del corazón, un
resfriado o congestionamiento, epilepsia, asma o un problema
médico severo, o que esté bajo la influencia del alcohol o
drogas, no debe bucear. Si se está tomando medicamentos,
los participantes deberán consultar a un doctor y al instructor
antes de participar en este programa. Si hay alguna pregunta
sobre la conveniencia de la participación, contacte al médico
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 médicas con respecto a la participación 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
guía, favor de comunicarse con la base de aventura extrema que
está considerando visitar.
Medicamentos. Cada participante que tenga una condición
que requiera medicamentos deberá traer consigo la cantidad
apropiada para la duración 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 tétanos en los últimos 10 años. Se les dará
reconocimiento a los derechos de aquellos Scouts o Scouters que
no tienen vacunas a causa de creencias filosóficas, políticas o
religiosas. En dicha situación, se requiere el formulario Solicitud de
exención de inmunización.
Recomendaciones con respecto a enfermedades crónicas.
Cada base requiere que se le comunique esta información a
los padres o tutores y médico que realice el examen de cada
participante. No hay instalaciones para atención o tratamiento
prolongado, por lo tanto, los participantes que no puedan cumplir
con dichos requisitos serán enviados a casa y deben asumir los
gastos.
El personal y los médicos del personal se reservan el
derecho de negarle la participación a cualquier individuo
con base en el examen físico o historial médico.
Los adultos o niños que hayan tenido cualquiera de las
siguientes condiciones, deberán someterse a una evaluación
por parte de un médico antes de considerar participar en una
base de aventura extrema BSA.
Enfermedad cardiaca o cardiovascular, incluyendo:
1. Angina (dolor de pecho causado por vasos sanguíneos
bloqueados o que vienen del corazón).
2. Infarto al miocardio (ataque al corazón).
3. Cirugía de corazón o cateterismo cardiaco, incluyendo
angioplastia (dilatación con balón) o stents para tratar vasos
sanguíneos bloqueados.
4. Derrame cerebral o ataques isquémicos transitorios (AIT).
5. Claudicación (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 años
de edad.
7.Diabetes.
8.Tabaquismo.
9. Exceso de peso.
Page 3 of 8
Participants who have a congenital heart disease or an
acquired heart disease such as rheumatic fever, Kawasaki’s
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 significant hypertension (greater than 140/90) should
be treated and controlled before attending any highadventure 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 jóvenes que tengan alguna enfermedad cardiaca congénita
o enfermedad cardiaca adquirida como fiebre reumática,
enfermedad de Kawasaki o prolapso de la válvula mitral deberán
someterse a un examen médico exhaustivo antes de considerar
participar en una base de aventura extrema. El esfuerzo físico en
cualquiera de las bases de aventura extrema puede precipitar
ya sea un ataque al corazón o derrame cerebral en las personas
susceptibles. Los participantes con antecedentes de cualquiera de
las primeras siete condiciones enumeradas anteriormente deberán
someterse a una prueba de esfuerzo supervisada por un médico.
Se recomiendan pruebas más exhaustivas (por ejemplo, prueba de
esfuerzo con radioisótopos) 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.
Hipertensión (Presión arterial alta). La combinación de estrés
físico, mental y emocional, el aumento de esfuerzo y de calor,
y la altura, aparentemente causan un incremento significativo
en la presión arterial en algunos individuos. En ocasiones, la
hipertensión alcanza tal nivel que no es seguro participar en una
actividad vigorosa. La hipertensión puede incrementar el riesgo
de tener un derrame cerebral, ataque al corazón o angina. Los
participantes deben tener una presión arterial normal menor
de 140/90. Las personas con una hipertensión importante (mayor a
140/90) deberán estar bajo tratamiento y su condición debe estar
controlada antes de que acudan a cualquier base de aventura
extrema, y deberán continuar con sus medicamentos mientras
participen. El objetivo del tratamiento debe ser disminuir
la presión arterial a niveles normales. Aquellos que ya se
encuentren bajo tratamiento antihipertensivo y que tengan una
presión arterial normal deberán continuar con su tratamiento. Los
individuos que tomen diuréticos para tratar la hipertensión corren
un mayor riesgo de deshidratación relacionada con actividad física
desgastante y deberán tener cuidado de mantener una muy buena
hidratación durante la excursión.
Philmont. A cada participante que tenga 18 años de edad o
más se le tomará la presión en Philmont. Aquellos individuos
con presión arterial consistentemente mayor a 160/100 en
Philmont serán apartados del sendero hasta que la presión
arterial disminuya.
Base Marina de la Florida. Quienes toman medicamentos beta
bloqueadores deberían 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 deberá ser capaz de autocontrolar su nivel de glucosa
en la sangre y saber cómo ajustar las dosis de insulina con base
en estos factores. Las personas con diabetes también deben
saber cómo inyectarse. Tanto la persona con diabetes y otra
más en el grupo debe saber reconocer los síntomas de niveles
excesivamente altos de azúcar (hiperglucemia o cetoacidosis
diabética) y los de niveles excesivamente bajos de azúcar en la
sangre (hipoglicemia). La persona con diabetes y otra persona
más deberán saber las respuestas iniciales apropiadas para dichas
condiciones. Una persona dependiente de insulina que haya sido
diagnosticada recientemente (en los últimos 6 meses) o que se
haya sometido a un cambio en el sistema de dosificación (por
ejemplo, una bomba para insulina) en el mismo periodo no deberá
intentar participar. Una persona que haya sido hospitalizada
frecuentemente debido a cetoacidosis diabética o que haya tenido
problemas frecuentes de hipoglicemia, no deberá participar hasta
que se obtenga un mejor control de la diabetes.
Page 4 of 8
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-related
illnesses within the past year, the individual must obtain
permission to participate by contacting the Philmont
Health Lodge at 575-376-2281.
Philmont. Se recomienda que la persona con diabetes y otra
persona más lleve consigo insulina en el recorrido (en caso de
un accidente) y que una tercera ampolleta sea guardada en el
pabellón médico como reserva. Lleve la insulina en un pequeño
recipiente aislante. Lleve suficientes suministros de prueba para
el viaje y el recorrido. Normalmente se requieren adicionales.
Si un individuo ha sido hospitalizado por enfermedades
relacionadas con la diabetes en el último año, el individuo debe
obtener permiso para participar llamando al Pabellón médico de
Philmont al 575-376-2281.
Florida Sea Base. Persons with diabetes who are 18 years
of age or older who wish to scuba dive should be assessed
by a physician familiar with both hyperbaric issues related
to diabetes and medications used for the control and
treatment of diabetes. Persons 18 years old or older who are
determined to be candidates for scuba diving must submit
four hemoglobin A1c (HbA1c) tests, each with HbA1c values
less than 7, taken within the previous 12 months. Any test
within the past 12 months with an HbA1c value greater than
7 disqualifies a person from scuba diving as part of a BSA
activity.
Persons less than 18 years of age with Type 1 diabetes
will not be allowed to scuba dive. Persons under the age
of 18 who control their diabetes with exercise and diet (no
medications) and can provide three sequential hemoglobin
tests with HbA1c values less than 6 may be approved to
scuba dive.
Base Marina de la Florida. Las personas con diabetes que
tengan 18 años de edad o más que deseen bucear, deberán ser
evaluados por un médico familiar tanto en temas hiperbáricos
relacionados con la diabetes, como medicamentos utilizados
para el control y tratamiento de la diabetes. Las personas de
18 años de edad o más que sean determinadas como candidatos
para bucear, deben remitir cuatro pruebas de hemoglobina A1c
(HbA1c), cada una con valores HbA1c menores a 7, tomadas
dentro de los 12 meses anteriores. Cualquier prueba dentro de
los últimos 12 meses con un valor HbA1c mayor a 7 descalifica a
dicha persona de bucear como parte de una actividad BSA.
Seizures (Epilepsy). A seizure disorder or epilepsy does not
exclude an individual from participating at a high-adventure
base. However, the seizure disorder should be wellcontrolled by medications. A minimum one year seizure-free
period is considered to be adequate control. Exceptions to
this guideline may be considered on an individual basis, and
will be based on the specific type of seizure and the likely
risks to the individual and to other members of the crew.
Florida Sea Base. Any seizure activity within the past five
years, regardless of control and/or medication, disqualifies
an individual from participation in any scuba program.
A person with a history of seizure activity who has been
asymptomatic AND medication-free for five years, as
evidenced by a physician, will be allowed to dive.
Asthma. Asthma should be well-controlled before
participating at any high-adventure base. Well-controlled
asthma means: 1) the use of a rescue inhaler (e.g., albuterol)
less than once daily; 2) no need for nighttime treatment with
a rescue inhaler (e.g., albuterol). Well-controlled asthma
may include the use of long-acting bronchodilators, inhaled
steroids, or oral medications such as Singulair. You must
meet these guidelines in order to participate. You may not
be allowed to participate if: 1) you have exercise asthma not
controlled by medications; or 2) you have been hospitalized
or have gone to the emergency room to treat asthma in
the past six months; or 3) you have needed treatment with
intravenous, intramuscular, or oral steroids (prednisone) in
the past six months. You must bring an ample supply of your
medications and a spare rescue inhaler that are not expired.
At least one other member of the crew should know how to
recognize signs of worsening asthma or an asthma attack,
and should know how to use the rescue inhaler. Any person
who has needed treatment for asthma in the past three
years must carry a rescue inhaler on the trek. If you do
not bring a rescue inhaler, you must buy one before you
will be allowed to participate.
Las personas menores de 18 años de edad con diabetes Tipo
1 no podrán bucear. Las personas menores de 18 años que
controlan su diabetes con ejercicio y dieta (no medicamentos)
y que puedan proporcionar tres pruebas secuenciales de
hemoglobina con valores HbA1c menores a 6, pueden ser
aprobadas para bucear.
Convulsiones (Epilepsia). Las convulsiones o epilepsia no
excluyen a un individuo de participar en una base de aventura
extrema. Sin embargo, la enfermedad debe estar bien controlada
con medicamentos. Se considera como bajo control cuando
existe un periodo mínimo de un año sin convulsiones. Se pueden
considerar excepciones a estos lineamientos según cada caso
individual y se basará en el tipo específico de convulsión y la
posibilidad de riesgo para el individuo y a los otros miembros del
grupo.
Base Marina de la Florida. Cualquier convulsión dentro de los
últimos cinco años, sin importar el control o el medicamento,
descalifica a un individuo de participar en cualquier programa de
buceo. Una persona con antecedentes de convulsiones que ha
estado sin síntomas Y sin medicamentos por cinco años, según
lo acredite un médico, podrá bucear.
Asma. El asma deberá estar bien controlada antes de participar
en cualquier base de aventura extrema. Un asma bien controlada
significa: 1) el uso de un inhalador de rescate (por ejemplo,
albuterol) menos de una vez al día; 2) no tener la necesidad de
tratamiento durante la noche con un inhalador de rescate (por
ejemplo, albuterol). El asma bien controlada puede incluir el uso
de broncodilatadores de larga duración, esteroides inhalados o
medicamentos orales como Singulair. Usted debe cumplir con
los siguientes lineamientos a fin de participar. No se le permitirá
participar si: 1) tiene asma por ejercicio que no se previene con
medicamento; ó 2) ha sido hospitalizado o ha acudido a urgencias
para tratamiento contra el asma en los últimos seis meses;
ó 3) ha necesitado tratamiento con esteroides intravenosos,
intramusculares u orales (prednisona) en los últimos seis meses.
Debe llevar consigo suficientes suministros del medicamento e
inhaladores de rescate de repuesto que no hayan caducado. Por
lo menos otro miembro del grupo debe saber cómo reconocer
las señales de empeoramiento de asma o un ataque de asma y
deberá saber cómo utilizar el inhalador de rescate. Cualquier
persona que haya necesitado tratamiento para el asma en los
últimos tres años, debe llevar consigo un inhalador de rescate
durante el recorrido. Si no trae uno, debe comprarlo antes de
que se le permita participar.
Page 5 of 8
Florida Sea Base. Persons being treated for asthma
(including reactive airway disease) are disqualified from BSA
scuba programs. Persons with a history of asthma who
have been asymptomatic and have not used medications
to control asthma for five years or more may be allowed
to scuba dive as part of a BSA activity upon submission
of evidence from their treating physician. Persons with
a history of asthma who have been asymptomatic and
have not used medication to control asthma for less than
five years may be allowed to scuba dive as part of a BSA
activity upon submission of a methacholine challenge test
showing the asthma to be resolved.
Base Marina de la Florida. Las personas que reciben
tratamiento para el asma (incluyendo enfermedad reactiva de
las vías respiratorias) son descalificadas de los programas de
buceo BSA. Las personas con antecedentes de asma que no
han tenido síntomas y que no han usado medicamentos para
el control del asma durante cinco años o más, pueden bucear
como parte de una actividad BSA una vez que remitan evidencia
de su médico. Las personas con antecedentes de asma que no
han tenido síntomas y que no han usado medicamentos para el
control del asma durante menos de cinco años, pueden bucear
como parte de una actividad BSA una vez que remitan una
prueba de metacolina que muestre que el asma ha sido resuelta.
Allergy or Anaphylaxis. Persons who have had an
anaphylactic reaction from any cause must contact the
high-adventure base before arrival. If you are allowed
to participate, you will be required to have appropriate
treatment with you. You and at least one other member of
your crew must know how to give the treatment. If you do
not bring appropriate treatment with you, you will be required
to buy it before you will be allowed to participate.
Alergia o anafilaxia. Las personas que han tenido una reacción
anafiláctica por cualquier causa, deben contactar a la base de
aventura extrema antes de llegar. Si a usted le han permitido
participar, se le requerirá que tenga el tratamiento adecuado con
usted. Usted y por lo menos otro miembro de su grupo debe
saber cómo administrar el tratamiento. Si usted no trae consigo el
tratamiento apropiado, se le requerirá que lo compre antes de que
se le permita participar.
Recent Musculoskeletal Injuries and Orthopedic Surgery.
Every participant will put a great deal of strain on feet,
ankles, and knees due to negotiating steep, rocky trails
with a backpack; paddling and portaging heavy gear over
irregular terrain; or climbing into and out of a boat. Therefore,
individuals with significant musculoskeletal problems
(including back problems) or orthopedic surgery/injuries within
the last 6 months must have a letter of clearance from their
orthopedic surgeon or treating physician to be considered
for approval to participate. Permission is not guaranteed. A
person with a cast on any extremity may participate only if
approved by the high-adventure base. Ingrown toenails are
a common problem and must be treated 30 days prior to
arrival.
Lesiones musculoesqueléticas recientes y cirugía ortopédica
recientes. Cada participante ejercerá una gran cantidad de
presión en los pies, tobillos y rodillas a causa del efecto de andar
por un terreno empinado y senderos escabrosos cargando una
mochila; remando y cargando equipo pesado sobre terreno
irregular; o al subirse y salir de una embarcación. Por lo tanto,
los individuos con problemas musculoesqueléticos (incluyendo
problemas de la espalda) o lesiones/cirugías ortopédicas en los
últimos seis meses, deben tener una carta de autorización por
parte de su cirujano ortopedista o médico tratante para que sea
considerado para aprobación para participar. El permiso no se
garantiza. Una persona con un yeso en cualquier extremidad
puede participar sólo si lo aprueba la base de aventura extrema.
Las uñas encarnadas son un problema común y deben
tratarse un mes antes del evento.
Psychological and Emotional Difficulties. A psychological
disorder does not necessarily exclude an individual from
participation. Parents and advisers should be aware that no
high-adventure experience is designed to assist participants
in overcoming psychological or emotional problems.
Experience demonstrates that these problems frequently
become magnified, not lessened, when a participant is
subjected to the physical and mental challenges of a remote
wilderness setting. Any condition should be well-controlled
without the services of a mental health practitioner.
Under no circumstance should medication be stopped
immediately prior to participation, and medication should
be continued throughout the entire high-adventure
experience. Participants requiring medication must bring an
appropriate supply for the duration of the trip.
Weight Limits. Weight limit guidelines are used because
overweight individuals are at a greater risk for heart disease,
high blood pressure, stroke, altitude illness, sleep problems,
and injury. Those who fall within the limits are more likely to
have an enjoyable trek and avoid incurring health risks. These
guidelines are to be in use for all Scouting high-adventure
bases and high-adventure backcountry activities.
Philmont. Each participant in a Philmont trek must not
exceed the maximum acceptable limit in the weight chart
shown below. The right-hand column shows the maximum
acceptable weight for a person’s height in order to
participate in a Philmont trek.
Trastornos psicológicos y emocionales. Los trastornos
psicológicos no necesariamente excluyen a una persona de la
participación. Los padres y consejeros deben estar conscientes
de que ninguna experiencia de aventura extrema está diseñada
para ayudar a contrarrestar problemas psicológicos o emocionales.
La experiencia demuestra que estos problemas generalmente
aumentan, no disminuyen cuando un participante se somete
a los desafíos físicos y mentales de un ambiente remoto y
silvestre. Cualquier condición debe estar bien controlada sin los
servicios de un profesional del cuidado de la salud mental. Bajo
ninguna circunstancia se debe suspender el medicamento
inmediatamente antes de participar, y el medicamento deberá
continuarse durante la totalidad de la experiencia de aventura
extrema. Los participantes que necesiten medicamento deben
llevar la cantidad adecuada para la duración del viaje.
Límites de peso. Las reglas de límite de peso son utilizadas ya
que los individuos con exceso de peso corren mayor riesgo de
ataque al corazón, presión arterial elevada, derrame cerebral,
enfermedades de altitud, trastornos del sueño y lesiones. Quienes
están dentro de los límites tienen más posibilidades de tener una
excursión placentera y evitar incurrir en riesgos de salud. Estos
lineamientos deben utilizarse en todas las bases Scouting de
aventura extrema y actividades de aventura extrema en terrenos
aislados.
Philmont. Cada participante en una excursión en Philmont no
debe exceder el límite máximo aceptable en la tabla de peso que
se muestra a continuación. La columna a la derecha muestra el
peso máximo aceptable para la estatura de una persona a fin de
poder participar en una excursión en Philmont.
Page 6 of 8
Participants 21 years and older who exceed the
maximum acceptable weight limit for their height at
the Philmont medical recheck WILL NOT be permitted
to backpack or hike at Philmont. They will be sent
home. For example, a person 70 inches tall cannot weigh
more than 226 pounds. All heights and weights will be
measured in stocking feet.
Los participantes de 21 años de edad o más que excedan
el límite de aceptación máxima de peso correspondiente
a su altura en la revisión médica en Philmont, NO podrán
excursionar o ir de expedición con mochila en Philmont.
Serán enviados a casa. Por ejemplo, una persona de
70 pulgadas de estatura no puede pesar más de 226 libras. Todas
las estaturas y pesos serán medidos con calcetines puestos.
For participants under 21 years of age who exceed the
maximum acceptable weight for height, the Philmont
physicians will use their best professional judgment
in determining participation in a Philmont trek.
Philmont will consider up to 20 pounds over the maximum
acceptable as stated on the chart; however exceptions
are not made automatically, and discussion in
advance with Philmont is required regarding any
exception to the weight limit for persons under 21
years of age. Philmont’s telephone number is 575-3762281.
Para los participantes menores de 21 años que excedan el
límite de aceptación máxima de peso correspondiente a su
altura, los médicos de Philmont utilizarán su mejor juicio
profesional para determinar la participación en un recorrido
en Philmont. Philmont considerará hasta 20 libras sobre la
aceptación máxima tal como se establece en la tabla; sin
embargo, las excepciones no se realizan automáticamente,
y se requiere un análisis por adelantado con Philmont
con respecto a cualquier excepción al límite de peso para
personas menores de 21 años de edad. El teléfono de
Philmont es 575-376-2281.
Under no circumstances will any individual weighing
more than 295 pounds be permitted to participate in
backcountry programs. This requirement is necessary
due to rescue equipment restrictions and for the safety of
search-and-rescue personnel.
Bajo ninguna circunstancia se le permitirá a ningún individuo
que pese más de 295 libras participar en los programas en
las áreas campestres. Este requisito es necesario debido a
las restricciones del equipo de rescate y por la seguridad del
personal de búsqueda y rescate.
The maximum weight for any participant in a Cavalcade
Trek and for horse rides is 200 pounds.
El peso máximo para cualquier participante en el Sendero
Cavalcade y para montar a caballo es 200 libras.
Participants and guests in Philmont activities, including
most Philmont Training Center conference and family
programs, who will participate in limited backcountry
access during their visit must not exceed the maximum
acceptable limit in the weight chart.
Los participantes e invitados de las actividades Philmont,
incluyendo la mayoría de las conferencias y programas familiares
del Centro de Capacitación Philmont que participarán en zonas
campestres con acceso limitado durante su visita, no deben
exceder el límite máximo aceptable en la tabla de peso.
Northern Tier. Each participant in a Northern Tier
expedition should not exceed the maximum acceptable
weight for height in the table shown on the Annual Health
and Medical Record form. Those who fall within the
recommended weight limits are much more likely to have
an enjoyable trek and avoid incurring injuries and health
risks. Extra weight puts strain on the back, joints, and
feet. The portage trails can be very muddy, slippery, and
rocky, and present a potential for tripping and falling.
We also strongly recommend that no participant be less
than 100 pounds in weight. Extremely small participants
will have a very difficult time carrying canoes and heavy
packs.
Canoes’ loads are another important reason to limit
participant weight. Northern Tier assigns three people to
a canoe. The total participant load per canoe must not
exceed 600 pounds, or an average of 200 pounds per
participant. Northern Tier does not permit individuals
exceeding 295 pounds to participate in high-adventure
programs.
Florida Sea Base. Any participant or advisor who
exceeds the maximum weight limits on the weight chart
may want to reconsider participation in a Sea Base highadventure program. Anyone who exceeds these limits is
at extreme risk for health problems. Participants who fall
within the guidelines are more likely to have an enjoyable
program and avoid incurring health risks. The absolute
weight limit for our programs is 295 pounds.
Northern Tier. Cada participante en una expedición en
Northern Tier no deberá exceder el peso máximo aceptable
correspondiente a su estatura según la tabla que se muestra
en el Registro Médico y de Seguridad Anual. Aquellos que
entran en los límites de peso recomendables tienen mayor
posibilidad de tener un trayecto agradable y evitar incurrir en
lesiones y riesgos de salud. El exceso de peso causa estragos
en la espalda, articulaciones y pies. Los senderos para trasladar
embarcaciones pueden ser fangosos, resbalosos y pedregosos,
y presentar riesgos de tropezones y caídas. Asimismo,
recomendamos encarecidamente que no haya participantes que
pesen menos de 100 libras. Los participantes extremadamente
pequeños tendrán dificultad para cargar canoas y mochilas
pesadas.
Las cargas de las canoas son otra razón importante para limitar
el peso. Northern Tier asigna tres personas por canoa. La carga
total de los participantes por canoa no debe exceder 600 libras,
o un promedio de 200 libras por participante. Northern Tier no
permite a los individuos que excedan 295 libras que participen
en programas de aventura extrema.
Base Marina de la Florida. Cualquier participante o consejero
que exceda los límites máximos de peso en la tabla quizá
quiera reconsiderar su participación en el programa de aventura
extrema en una Base Marina. Cualquiera que exceda dichos
límites está en riesgo grave de tener problemas de salud.
Los participantes que entran en los lineamientos tienen más
posibilidades de disfrutar del programa y evitar incurrir en
riesgos de la salud. El peso límite absoluto para nuestros
programas es 295 libras.
Page 7 of 8
Summit Bechtel Reserve. The Summit Bechtel Reserve
offers many types of activities that can be physically
demanding, including rock climbing, mountain biking,
white-water rafting, zip-line canopy tours, and more. Due
to the mountainous terrain and remote location, there
are safety precautions that must be followed. Check the
Summit’s website for more specific information: https://
summit.scouting.org/en/Pages/default.aspx. Please
contact the Summit Bechtel Reserve at 304-250-6750 if
you have any questions.
Height
(inches)
Summit Bechtel Reserve. Este lugar ofrece muchos tipos de
actividades que pueden ser físicamente exigentes, incluyendo
escalada en roca, ciclismo de montaña, descenso en ríos,
recorridos en tirolesa y mucho más. Debido a los terrenos
montañosos y ubicación remota, se deben seguir precauciones
de seguridad. Consulte el sitio web de Summit para obtener
información más específica: https://summit.scouting.org/en/
Pages/default.aspx. Favor de contactar a Summit Bechtel
Reserve al 304-250-6750 si tiene más preguntas.
Recommended
Weight (lbs)
Allowable
Exception
Maximum
Acceptance
Estatura
(pulgadas)
Recommended
Weight (lbs)
Peso recomendado
(libras)
Allowable
Exception
Maximum
Acceptance
Aceptación
máxima
60
97-138
139-166
61
101-143
144-172
166
71
136-194
195-233
233
172
72
140-199
200-239
62
104-148
239
149-178
178
73
144-205
206-246
63
246
107-152
153-183
183
74
148-210
211-252
252
64
111-157
158-189
189
75
152-216
217-260
260
65
114-162
163-195
195
76
156-222
223-267
267
66
118-167
168-201
201
77
160-228
229-274
274
67
121-172
173-207
207
78
164-234
235-281
281
68
125-178
179-214
214
69
129-185
186-220
220
79 & over
79 y más
170-240
241-295
295
70
132-188
189-226
226
Estatura
(pulgadas)
Peso recomendado
(libras)
Excepción
permitida
Height
(inches)
Excepción
permitida
Aceptación
máxima
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 está basada en la revisión de las Directrices dietéticas para estadounidenses del Departamento de Agricultura y del Departamento de
Salud y Servicios Humanos de los EE.UU.
Page 8 of 8
680-001
2012 Printing
Rev. 9/2012
MEDICAL STATEMENT
Participant Record (Confidential Information)
Please read carefully before signing.
This is a statement in which you are informed of some potential risks
involved in scuba diving and of the conduct required of you during the
scuba training program. Your signature on this statement is required for
you to participate in the scuba training program offered
by_____________________________________________________and
Instructor
_______________________________________________located in the
Facility
city of_______________________, state/province of _______________.
Read this statement prior to signing it. You must complete this
Medical Statement, which includes the medical questionnaire section, to
enroll in the scuba training program. If you are a minor, you must have
this Statement signed by a parent or guardian.
Diving is an exciting and demanding activity. When performed
correctly, applying correct techniques, it is relatively safe. When
established safety procedures are not followed, however, there are
increased risks.
To scuba dive safely, you should not be extremely overweight or
out of condition. Diving can be strenuous under certain conditions. Your
respiratory and circulatory systems must be in good health. All body air
spaces must be normal and healthy. A person with coronary disease, a
current cold or congestion, epilepsy, a severe medical problem or who is
under the influence of alcohol or drugs should not dive. If you have
asthma, heart disease, other chronic medical conditions or you are taking medications on a regular basis, you should consult your doctor and
the instructor before participating in this program, and on a regular basis
thereafter upon completion. You will also 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. You
must be thoroughly instructed in its use under direct supervision of a
qualified instructor to use it safely.
If you have any additional questions regarding this Medical
Statement or the Medical Questionnaire section, review them with your
instructor before signing.
Divers Medical Questionnaire
To the Participant:
The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in recreational diver training. A positive
response to a question does not necessarily disqualify you from diving. A positive
response means that there is a preexisting condition that may affect your safety
while diving and you must seek the advice of your physician prior to engaging in
dive activities.
Please answer the following questions on your past or present medical history
with a YES or NO. If you are not sure, answer YES. If any of these items apply to
you, we must request that you consult with a physician prior to participating in
scuba diving. Your instructor will supply you with an RSTC Medical Statement and
Guidelines for Recreational Scuba Diver’s Physical Examination to take to your
physician.
_____ Could you be pregnant, or are you attempting to become pregnant?
_____ Dysentery or dehydration requiring medical intervention?
_____ Are you presently taking prescription medications? (with the exception of
birth control or anti-malarial)
_____ Any dive accidents or decompression sickness?
_____ Are you over 45 years of age and can answer YES to one or more of the
following?
• currently smoke a pipe, cigars or cigarettes
• have a high cholesterol level
• have a family history of heart attack or stroke
• are currently receiving medical care
• high blood pressure
• diabetes mellitus, even if controlled by diet alone
Have you ever had or do you currently have…
_____ Asthma, or wheezing with breathing, or wheezing with exercise?
_____ Frequent or severe attacks of hayfever or allergy?
_____ Frequent colds, sinusitis or bronchitis?
_____ Any form of lung disease?
_____ Pneumothorax (collapsed lung)?
_____ Other chest disease or chest surgery?
_____ Behavioral health, mental or psychological problems (Panic attack, fear of
closed or open spaces)?
_____ Epilepsy, seizures, convulsions or take medications to prevent them?
_____ Recurring complicated migraine headaches or take medications to prevent them?
_____ Blackouts or fainting (full/partial loss of consciousness)?
_____ Frequent or severe suffering from motion sickness (seasick, carsick,
etc.)?
_____ Inability to perform moderate exercise (example: walk 1.6 km/one mile
within 12 mins.)?
_____ Head injury with loss of consciousness in the past five years?
_____ Recurrent back problems?
_____ Back or spinal surgery?
_____ Diabetes?
_____ Back, arm or leg problems following surgery, injury or fracture?
_____ High blood pressure or take medicine to control blood pressure?
_____ Heart disease?
_____ Heart attack?
_____ Angina, heart surgery or blood vessel surgery?
_____ Sinus surgery?
_____ Ear disease or surgery, hearing loss or problems with balance?
_____ Recurrent ear problems?
_____ Bleeding or other blood disorders?
_____ Hernia?
_____ Ulcers or ulcer surgery ?
_____ A colostomy or ileostomy?
_____ Recreational drug use or treatment for, or alcoholism in the past five
years?
The information I have provided about my medical history is accurate to the best of my knowledge. I agree to accept
responsibility for omissions regarding my failure to disclose any existing or past health condition.
_______________________________________ _________________
Signature
_______________________________________ _________________
Date
Signature of Parent or Guardian
PRODUCT NO. 10063 (Rev. 06/07) Ver. 2.01
Page 1 of 6
Date
© PADI 1989, 1990, 1998, 2001, 2007
© Recreational Scuba Training Council, Inc. 1989, 1990, 1998, 2001, 2007
STUDENT
Please print legibly.
Name__________________________________________________________________________
First
Initial
Last
Birth Date ________________ Age ________
Day/Month/Year
Mailing Address __________________________________________________________________________________________________________
City________________________________________________________________ State/Province/Region ________________________________
Country ____________________________________________________________
Home Phone (
)________________________________________
Email _____________________________________________________
Zip/Postal Code _____________________________________
Business Phone (
)______________________________________
FAX_______________________________________________________
Name and address of your family physician
Physician __________________________________________________
Clinic/Hospital ______________________________________________
Address________________________________________________________________________________________________________________
Date of last physical examination ________________
Name of examiner____________________________________________
Clinic/Hospital_______________________________________________
Address ________________________________________________________________________________________________________________
Phone (
)___________________________________
Were you ever required to have a physical for diving?
Yes
Email ________________________________________________________________
No
If so, when?________________________________________________
PHYSICIAN
This person applying for training or is presently certified to engage in scuba (self-contained underwater breathing apparatus) diving. Your opinion of
the applicant’s medical fitness for scuba diving is requested. There are guidelines attached for your information and reference.
Physician’s Impression
I find no medical conditions that I consider incompatible with diving.
I am unable to recommend this individual for diving.
Remarks ___________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
__________________________________________________________________________ Date ___________________________
Physician’s Signature or Legal Representative of Medical Practitioner
Day/Month/Year
Physician_____________________________________________
Clinic/Hospital_________________________________________
Address____________________________________________________________________________________________________
Phone (
)___________________________________
Email ________________________________________________________________
Page 2 of 6
Guidelines for Recreational Scuba Diver’s Physical Examination
Instructions to the Physician:
Recreational SCUBA (Self-Contained Underwater Breathing
Apparatus) can provide recreational divers with an enjoyable
sport safer than many other activities. The risk of diving is
increased by certain physical conditions, which the relationship to
diving may not be readily obvious. Thus, it is important to screen
divers for such conditions.
The RECREATIONAL SCUBA DIVER’S PHYSICAL EXAMINATION focuses on conditions that may put a diver at increased risk
for decompression sickness, pulmonary overinflation syndrome
with subsequent arterial gas embolization and other conditions
such as loss of consciousness, which could lead to drowning.
Additionally, the diver must be able to withstand some degree of
cold stress, the physiological effects of immersion and the optical
effects of water and have sufficient physical and mental reserves
to deal with possible emergencies.
The history, review of systems and physical examination should
include as a minimum the points listed below. The list of conditions that might adversely affect the diver is not all-inclusive, but
contains the most commonly encountered medical problems. The
brief introductions should serve as an alert to the nature of the
risk posed by each medical problem.
The potential diver and his or her physician must weigh the
pleasures to be had by diving against an increased risk of death
or injury due to the individual’s medical condition. As with any
recreational activity, there are no data for diving enabling the calculation of an accurate mathematical probability of injury. Experience and physiological principles only permit a qualitative
assessment of relative risk.
For the purposes of this document, Severe Risk implies that an
individual is believed to be at substantially elevated risk of decompression sickness, pulmonary or otic barotrauma or altered consciousness with subsequent drowning, compared with the general population. The consultants involved in drafting this document
would generally discourage a student with such medical problems from diving. Relative Risk refers to a moderate increase in
risk, which in some instances may be acceptable. To make a
decision as to whether diving is contraindicated for this category
of medical problems, physicians must base their judgement on
an assessment of the individual patient. Some medical problems
which may preclude diving are temporary in nature or responsive to treatment, allowing the student to dive safely after they
have resolved.
Diagnostic studies and specialty consultations should be obtained
as indicated to determine the diver’s status. A list of references is
included to aid in clarifying issues that arise. Physicians and
other medical professionals of the Divers Alert Network (DAN)
associated with Duke University Health System are available for
consultation by phone +1 919 684 2948 during normal business
hours. For emergency calls, 24 hours 7 days a week, call +1 919
684 8111 or +1 919 684 4DAN (collect). Related organizations
exist in other parts of the world – DAN Europe in Italy +39 039
605 7858, DAN S.E.A.P. in Australia +61 3 9886 9166 and Divers
Emergency Service (DES) in Australia +61 8 8212 9242, DAN
Japan +81 33590 6501 and DAN Southern Africa +27 11 242
0380. There are also a number of informative websites offering
similar advice.
NEUROLOGICAL
Neurological abnormalities affecting a diver’s ability to perform
exercise should be assessed according to the degree of compromise. Some diving physicians feel that conditions in which there
can be a waxing and waning of neurological symptoms and
signs, such as migraine or demyelinating disease, contraindicate
diving because an exacerbation or attack of the preexisting disease (e.g.: a migraine with aura) may be difficult to distinguish
from neurological decompression sickness. A history of head
injury resulting in unconsciousness should be evaluated for risk
of seizure.
Relative Risk Conditions
• Complicated Migraine Headaches whose symptoms or
severity impair motor or cognitive function, neurologic
manifestations
• History of Head Injury with sequelae other than seizure
• Herniated Nucleus Pulposus
• Intracranial Tumor or Aneurysm
• Peripheral Neuropathy
• Multiple Sclerosis
• Trigeminal Neuralgia
• History of spinal cord or brain injury
Temporary Risk Condition
History of cerebral gas embolism without residual where pulmonary air trapping has been excluded and for which there
is a satisfactory explanation and some reason to believe that
the probability of recurrence is low.
Severe Risk Conditions
Any abnormalities where there is a significant probability of
unconsciousness, hence putting the diver at increased risk of
drowning. Divers with spinal cord or brain abnormalities where
perfusion is impaired may be at increased risk of decompression
sickness.
Some conditions are as follows:
• History of seizures other than childhood febrile seizures
• History of Transient Ischemic Attack (TIA) or Cerebrovascular Accident (CVA)
• History of Serious (Central Nervous System, Cerebral or
Inner Ear) Decompression Sickness with residual deficits
CARDIOVASCULAR SYSTEMS
The diagnoses listed below potentially render the diver unable to
meet the exertional performance requirements likely to be
encountered in recreational diving. These conditions may lead
the diver to experience cardiac ischemia and its consequences.
Formalized stress testing is encouraged if there is any doubt
regarding physical performance capability. The suggested minimum criteria for stress testing in such cases is at least 13
METS.* Failure to meet the exercise criteria would be of significant concern. Conditioning and retesting may make later qualification possible. Immersion in water causes a redistribution of
blood from the periphery into the central compartment, an effect
that is greatest in cold water. The marked increase in cardiac
preload during immersion can precipitate pulmonary edema in
patients with impaired left ventricular function or significant valvular disease. The effects of immersion can mostly be gauged by
an assessment of the diver’s performance while swimming on the
surface. A large proportion of scuba diving deaths in North America are due to coronary artery disease. Before being approved to
scuba dive, individuals older than 40 years are recommended to
undergo risk assessment for coronary artery disease. Formal
exercise testing may be needed to assess the risk.
* METS is a term used to describe the metabolic cost. The MET at rest
is one, two METS is two times the resting level, three METS is three
times the resting level, and so on. The resting energy cost (net oxygen
requirement) is thus standardized. (Exercise Physiology; Clark, Prentice
Hall, 1975.)
Page 3 of 6
• Obesity
• History of Coronary Artery Bypass Grafting (CABG)
• Percutaneous Balloon Angioplasty (PCTA) or Coronary
Artery Disease (CAD)
• History of Myocardial Infarction
• Congestive Heart Failure
• Hypertension
• History of dysrythmias requiring medication for suppression
• Valvular Regurgitation
• History of Immersion Pulmonary Edema Restrictive Disease*
• Interstitial lung disease: May increase the risk of pneumothorax
* Spirometry should be normal before and after exercise
Active Reactive Airway Disease, Active Asthma, Exercise
Induced Bronchospasm, Chronic Obstructive Pulmonary
Disease or history of same with abnormal PFTs or a positive
exercise challenge are concerns for diving.
Pacemakers
The pathologic process that necessitated should be
addressed regarding the diver’s fitness to dive. In those
instances where the problem necessitating pacing does not
preclude diving, will the diver be able to meet the performance criteria?
* NOTE: Pacemakers must be certified by the manufacturer as able
to withstand the pressure changes involved in recreational diving.
Severe Risks
PULMONARY
Any process or lesion that impedes airflow from the lungs places
the diver at risk for pulmonary overinflation with alveolar rupture
and the possibility of cerebral air embolization. Many interstitial
diseases predispose to spontaneous pneumothorax: Asthma
(reactive airway disease), Chronic Obstructive Pulmonary Disease (COPD), cystic or cavitating lung diseases may all cause air
trapping. The 1996 Undersea and Hyperbaric Medical Society
(UHMS) consensus on diving and asthma indicates that for the
risk of pulmonary barotrauma and decompression illness to be
acceptably low, the asthmatic diver should be asymptomatic and
have normal spirometry before and after an exercise test.
Inhalation challenge tests (e.g.: using histamine, hypertonic
saline or methacholine) are not sufficiently standardized to be
interpreted in the context of scuba diving.
A pneumothorax that occurs or reoccurs while diving may be catastrophic. As the diver ascends, air trapped in the cavity
expands and could produce a tension pneumothorax.
In addition to the risk of pulmonary barotrauma, respiratory disease due to either structural disorders of the lung or chest wall or
neuromuscular disease may impair exercise performance. Structural disorders of the chest or abdominal wall (e.g.: prune belly),
or neuromuscular disorders, may impair cough, which could be
life threatening if water is aspirated. Respiratory limitation due to
disease is compounded by the combined effects of immersion
(causing a restrictive deficit) and the increase in gas density,
which increases in proportion to the ambient pressure (causing
increased airway resistance). Formal exercise testing may be
helpful.
• History of Asthma or Reactive Airway Disease (RAD)*
• History of Exercise Induced Bronchospasm (EIB)*
• History of solid, cystic or cavitating lesion*
• Pneumothorax secondary to:
-Thoracic Surgery
-Trauma or Pleural Penetration*
-Previous Overinflation Injury*
• History of spontaneous pneumothorax. Individuals who
have experienced spontaneous pneumothorax should avoid
diving, even after a surgical procedure designed to prevent
recurrence (such as pleurodesis). Surgical procedures either
do not correct the underlying lung abnormality (e.g.: pleurodesis, apical pleurectomy) or may not totally correct it (e.g.: resection of blebs or bullae).
• Impaired exercise performance due to respiratory disease.
Venous emboli, commonly produced during decompression,
may cross major intracardiac right-to-left shunts and enter
the cerebral or spinal cord circulations causing neurological
decompression illness. Hypertrophic cardiomyopathy and
valvular stenosis may lead to the sudden onset of unconsciousness during exercise.
GASTROINTESTINAL
Temporary Risks
As with other organ systems and disease states, a process which
chronically debilitates the diver may impair exercise performance.
Additionally, dive activities may take place in areas remote from
medical care. The possibility of acute recurrences of disability or
lethal symptoms must be considered.
Temporary Risk Conditions
• Peptic Ulcer Disease associated with pyloric obstruction or
severe reflux
• Unrepaired hernias of the abdominal wall large enough to
contain bowel within the hernia sac could incarcerate.
• Inflammatory Bowel Disease
• Functional Bowel Disorders
Severe Risks
Altered anatomical relationships secondary to surgery or malformations that lead to gas trapping may cause serious problems.
Gas trapped in a hollow viscous expands as the divers surfaces
and can lead to rupture or, in the case of the upper GI tract, emesis. Emesis underwater may lead to drowning.
• Gastric outlet obstruction of a degree sufficient to produce
recurrent vomiting
• Chronic or recurrent small bowel obstruction
• Severe gastroesophageal reflux
• Achalasia
• Paraesophageal Hernia
ORTHOPAEDIC
Relative impairment of mobility, particularly in a boat or ashore
with equipment weighing up to 18 kgs/40 pounds must be
assessed. Orthopaedic conditions of a degree sufficient to impair
exercise performance may increase the risk.
• Amputation
• Scoliosis must also assess impact on respiratory function
and exercise performance.
• Aseptic Necrosis possible risk of progression due to
effects of decompression (evaluate the underlying medical
Page 4 of 6
cause of decompression may accelerate/escalate the progression).
Temporary Risk Conditions
• Back pain
HEMATOLOGICAL
Abnormalities resulting in altered rheological properties may theoretically increase the risk of decompression sickness. Bleeding
disorders could worsen the effects of otic or sinus barotrauma,
and exacerbate the injury associated with inner ear or spinal cord
decompression sickness. Spontaneous bleeding into the joints
(e.g.: in hemophilia) may be difficult to distinguish from decompression illness.
personal fears
Claustrophobia and agoraphobia
Active psychosis
History of untreated panic disorder
Drug or alcohol abuse
OTOLARYNGOLOGICAL
Equalisation of pressure must take place during ascent and
descent between ambient water pressure and the external auditory canal, middle ear and paranasal sinuses. Failure of this to
occur results at least in pain and in the worst case rupture of the
occluded space with disabling and possible lethal consequences.
The inner ear is fluid filled and therefore noncompressible. The
flexible interfaces between the middle and inner ear, the round
and oval windows are, however, subject to pressure changes.
Previously ruptured but healed round or oval window membranes
are at increased risk of rupture due to failure to equalise pressure
or due to marked overpressurisation during vigorous or explosive
Valsalva manoeuvres.
•
•
•
•
•
•
•
•
Sickle Cell Disease
Polycythemia Vera
Leukemia
Hemophilia/Impaired Coagulation
METABOLIC AND ENDOCRINOLOGICAL
With the exception of diabetes mellitus, states of altered hormonal or metabolic function should be assessed according to their
impact on the individual’s ability to tolerate the moderate exercise
requirement and environmental stress of sport diving. Obesity
may predispose the individual to decompression sickness, can
impair exercise tolerance and is a risk factor for coronary artery
disease.
The larynx and pharynx must be free of an obstruction to airflow.
The laryngeal and epiglotic structure must function normally to
prevent aspiration.
Mandibular and maxillary function must be capable of allowing
the patient to hold a scuba mouthpiece. Individuals who have
had mid-face fractures may be prone to barotrauma and rupture
of the air filled cavities involved.
• Hormonal Excess or Deficiency
• Obesity
• Renal Insufficiency
•
•
•
•
•
•
•
•
•
The potentially rapid change in level of consciousness associated with hypoglycemia in diabetics on insulin therapy or
certain oral hypoglycemic medications can result in drowning. Diving is therefore generally contraindicated, unless
associated with a specialized program that addresses these
issues. [See “Guidelines for Recreational Diving with Diabetes”
at www/wrstc.com and www.diversalertnetwork.org.]
Pregnancy: The effect of venous emboli formed during
decompression on the fetus has not been thoroughly investigated. Diving is therefore not recommended during any
stage of pregnancy or for women actively seeking to
become pregnant.
BEHAVIORAL HEALTH
Behavioral: The diver’s mental capacity and emotional make-up
are important to safe diving. The student diver must have sufficient learning abilities to grasp information presented to him by
his instructors, be able to safely plan and execute his own dives
and react to changes around him in the underwater environment.
The student’s motivation to learn and his ability to deal with
potentially dangerous situations are also crucial to safe scuba
diving.
•
•
•
•
Developmental delay
History of drug or alcohol abuse
History of previous psychotic episodes
Use of psychotropic medications
• Inappropriate motivation to dive – solely to please spouse,
partner or family member, to prove oneself in the face of
•
•
•
•
•
•
•
Recurrent otitis externa
Significant obstruction of external auditory canal
History of significant cold injury to pinna
Eustachian tube dysfunction
Recurrent otitis media or sinusitis
History of TM perforation
History of tympanoplasty
History of mastoidectomy
Significant conductive or sensorineural hearing impairment
Facial nerve paralysis not associated with barotrauma
Full prosthedontic devices
History of mid-face fracture
Unhealed oral surgery sites
History of head and/or neck therapeutic radiation
History of temperomandibular joint dysfunction
History of round window rupture
•
•
•
•
•
•
•
•
•
•
•
•
•
Monomeric TM
Open TM perforation
Tube myringotomy
History of stapedectomy
History of ossicular chain surgery
History of inner ear surgery
Facial nerve paralysis secondary to barotrauma
Inner ear disease other than presbycusis
Uncorrected upper airway obstruction
Laryngectomy or status post partial laryngectomy
Tracheostomy
Uncorrected laryngocele
History of vestibular decompression sickness
Page 5 of 6
BIBLIOGRAPHY/REFERENCE
1.
Bennett, P. & Elliott, D (eds.)(1993). The Physiology and Medicine
of Diving. 4th Ed., W.B. Saunders Company Ltd., London, England.
2.
Bove, A., & Davis, J. (1990). Diving Medicine. 2nd Edition, W.B.
Saunders Company, Philadelphia, PA.
3.
Davis, J., & Bove, A. (1986). “Medical Examination of Sport Scuba
Divers, Medical Seminars, Inc.,” San Antonio, TX
4.
Dembert, M. & Keith, J. (1986). “Evaluating the Potential Pediatric
Scuba Diver.” AJDC, Vol. 140, November.
5.
Edmonds, C., Lowry, C., & Pennefether, J. (1992) .3rd ed., Diving
and Subaquatic Medicine. Butterworth & Heineman Ltd., Oxford,
England.
6.
7.
8.
Neuman, T. & Bove, A. (1994). “Asthma and Diving.” Ann. Allergy,
Vol. 73, October, O’Conner & Kelsen.
9.
Shilling, C. & Carlston, D. & Mathias, R. (eds) (1984). The
Physician’s Guide to Diving Medicine. Plennum Press, New York,
NY.
10. Undersea and Hyperbaric Medical Society (UHMS)
www.UHMS.org
11. Divers Alert Network (DAN) United States, 6 West Colony Place,
Durham, NC www.DiversAlertNetwork.org
12. Divers Alert Network Europe, P.O. Box 64026 Roseto, Italy, telephone non-emergency line: weekdays office hours +39-085-8930333, emergency line 24 hours: +39-039-605-7858
Elliott, D. (Ed) (1994). “Medical Assessment of Fitness to Dive.”
Proceedings of an International Conference at the Edinburgh Conference Centre, Biomedical Seminars, Surry, England.
“Fitness to Dive,” Proceedings of the 34th Underwater & Hyperbaric
Medical Society Workshop (1987) UHMS Publication Number
70(WS-FD) Bethesda, MD.
13. Divers Alert Network S.E.A.P., P. O. Box 384, Ashburton, Australia, telephone 61-3-9886-9166
14. Divers Emergency Service, Australia, www.rah.sa.gov.au/hyperbaric, telephone 61-8-8212-9242
15. South Pacific Underwater Medicine Society (SPUMS), P.O. Box
190, Red Hill South, Victoria, Australia, www.spums.org.au
16. European Underwater and Baromedical Society, www.eubs.org
ENDORSERS
Paul A. Thombs, M.D., Medical Director
Hyperbaric Medical Center
St. Luke’s Hospital, Denver, CO, USA
Peter Bennett, Ph.D., D.Sc.
Professor, Anesthesiology
Duke University Medical Center
Durham, NC, USA
[email protected]
Richard E. Moon, M.D., F.A.C.P., F.C.C.P.
Departments of Anesthesiology and Pulmonary
Medicine
Durham, NC, USA
Roy A. Myers, M.D.
MIEMS
Baltimore, MD, USA
William Clem, M.D., Hyperbaric Consultant
Division Presbyterian/St. Luke’s Medical Center
Denver, CO, USA
John M. Alexander, M.D.
Northridge Hospital
Los Angeles, CA, USA
Des Gorman, B.Sc., M.B.Ch.B., F.A.C.O.M.,
F.A.F.O.M., Ph.D.
Professor of Medicine
University of Auckland, Auckland, NZ
[email protected]
Alf O. Brubakk, M.D., Ph.D.
Norwegian University of Science and Technology
Trondheim, Norway
[email protected]
Alessandro Marroni, M.D.
Director, DAN Europe
Roseto, Italy
Hugh Greer, M.D.
Santa Barbara, CA, USA
[email protected]
Christopher J. Acott, M.B.B.S., Dip. D.H.M.,
F.A.N.Z.C.A.
Physician in Charge, Diving Medicine
Royal Adelaide Hospital
Adelaide, SA 5000, Australia
Chris Edge, M.A., Ph.D., M.B.B.S., A.F.O.M.
Nuffield Department of Anaesthetics
Radcliffe Infirmary
Oxford, United Kingdom
[email protected]
Richard Vann, Ph.D.
Durham, NC, USA
Keith Van Meter, M.D., F.A.C.E.P.
Assistant Clinical Professor of Surgery
Tulane University School of Medicine
New Orleans, LA, USA
Robert W. Goldmann, M.D.
St. Luke’s Hospital
Milwaukee, WI, USA
Paul G. Linaweaver, M.D., F.A.C.P.
Santa Barbara Medical Clinic
Undersea Medical Specialist
Santa Barbara, CA, USA
James Vorosmarti, M.D.
6 Orchard Way South
Rockville, MD, USA
Tom S. Neuman, M.D., F.A.C.P., F.A.C.P.M.
Associate Director, Emergency Medical Services
Professor of Medicine and Surgery
University of California at San Diego
San Diego, CA, USA
Yoshihiro Mano, M.D.
Professor
Tokyo Medical and Dental University
Tokyo, Japan
[email protected]
Page 6 of 6
Simon Mitchell, MB.ChB., DipDHM, Ph.D.
Wesley Centre for Hyperbaric Medicine
Medical Director
Sandford Jackson Bldg., 30 Chasely Street
Auchenflower, QLD 4066 Australia
[email protected]
Jan Risberg, M.D., Ph.D.
NUI, Norway
Karen B.Van Hoesen, M.D.
Associate Clinical Professor
UCSD Diving Medicine Center
University of California at San Diego
San Diego, CA, USA
Edmond Kay, M.D., F.A.A.F.P.
Dive Physician & Asst. Clinical Prof. of Family Medicine
University of Washington
Seattle, WA, USA
[email protected]
Christopher W. Dueker, TWS, M.D.
Atherton, CA, USA
[email protected]
Charles E. Lehner, Ph.D.
Department of Surgical Sciences
University of Wisconsin
Madison, WI, USA
[email protected]
Undersea & Hyperbaric Medical Society
10531 Metropolitan Avenue
Kensington, MD 20895, USA
Diver’s Alert Network (DAN)
6 West Colony Place
Durham, NC 27705
San Gabriel Valley Council - Boy Scouts of America
Catalina Classic Cruises
Will be departing/returning from
The Catalina Express Terminal located by the
Queen Mary
Port of Long Beach Queen Mary
1046 Queens Highway, Long Beach, CA
PARKING FEES:
$15 daily per 24 hours and any part of 24 hours after the first day.
PAYABLE IN CASH ONLY
ATM AVAILABLE AT TERMINAL



Sunday Departure from Long Beach: 2:30 pm, 1:30 pm Check in
Saturday Departure from Two Harbor: 10:45 am
Monday Travel: Unit contact will receive an email with departure time
when council is notify that you need Monday travel.
Directions:
Take the 710 FWY South. Stay in the right lane; follow the signs to Queen Mary which will lead you to the Catalina Express
Terminal in the Queen Mary parking area. You will be met by staff.

Camp Cherry Valley - Greater Los Angeles Area Council

Transcripción

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