Please answer the questions below. Additional questions may be required depending on your answers. If entering a date, please enter it in MM/DD/YYYY format.

Adult Basic Information

@


Application Information

Add Another Previous Address
Add Another Previous Address
Add Another Previous Address
Add Another Previous Scouting Experience  
Add Another Previous Scouting Experience  







Merit Badge Counselor Information


Add Another MeritBadge
Add Another MeritBadge
Add Another MeritBadge
Add Another MeritBadge
Add Another MeritBadge
Add Another MeritBadge

Adult Health Information

Health History
Are you now, or have you ever been treated for any of the following:


Immunization History
The following are recommended by the BSA. Tetanus immunization is required and must have been received within the last 10 years. If had disease, check the Disease box and the year. If immunized, check the box and the year received.
Tetanus
Pertussis
Diptheria
Measles
Mumps
Rubella
Polio
Chicken Pox
Hepatitis A
Hepatitis B
Influenza
Other (i.e., HIB)

Allergies
Allergies or Reaction to:

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

Emergency Contact Information

Agreements

Activity Release
I understand that participation in Scouting activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding. I have carefully considered the risk involved and have given consent for myself or my child to participate in this activity. I also understand that participation in this activity is entirely voluntary and requires participants to abide by applicable rules and standards of conduct. 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.
In case of emergency involving my child, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose to the adult in charge 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.
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.


Talent Release
I hereby assign and grant to the local council and the Boy Scouts of America the right and permission to use and publish the photographs/film/videotapes/electronic representations and/or sound recordings made of me or my child at all Scouting activities, and I hereby release the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all liability from such use and publication.
I hereby authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said photographs/film/videotapes/electronic representations and/or sound recordings without limitation at the discretion of the Boy Scouts of America, and I specifically waive any right to any compensation I may have for any of the foregoing.


Generate Forms

Return to Scouting Applications

Copyright, © 2019 Troop 118

The copyrights to any and all text, graphics and software contained within this site are owned by Troop 118 of the Boy Scouts of America, the Boy Scouts of America, or individual copyright holders who have given permission for their content to be placed on this Web site. Any use without permission is in violation of federal copyright law. To inquire about obtaining rights for reuse, please contact Troop 118 at contact@troop118bsa.org.

Troop 118, its members, its chartering organization, St. Stephen's United Methodist Church, or the Boy Scouts of America, expresses no warranties or guarantees as to the accuracy of the information contained within this web site, or in any site or sites to which this site links, and does not accept professional liability or otherwise for the use or misuse of any information contained within this web site, or in any site or sites to which this site links. All information is subject to change without notice at anytime.