LEADER GUIDE SFC Everglades District

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LEADER GUIDE SFC Everglades District
SFC Everglades District
                    proudly presents

   WeBeLoS Woods 2021
FOLLOW YOUR SCOUTING COMPASS
           LEADER GUIDE

                          hosted at

         Camp Owaissa Bauer
   17001 SW 264th Street, Homestead, Florida

            April 16 – 18, 2021

     Note the issue date. New and developing information is
                                                               030121
     forthcoming. Check Council website for the latest copy.
LEADER GUIDE SFC Everglades District
SFC Everglades District                                                                     WeBeLoS Woods 2021

LETTER FROM THE CHIEF

WeBeLoS Den Leaders:
On behalf of the planning committee who have filled my
vision with stories, photos, songs, and scout spirit, I want to
welcome you and your WeBeLoS Scouts to WeBeloS Woods
2021. I am new to this event as most of you are and the fact
is I am just as nervous as some of our first year WeBeLoS
as to how this is going to go down. But I can assure you that
with the support of the Everglades District Committee and
local units volunteering here throughout this weekend, what
you are about to experience will be safe, enjoyable, and you
will leave here having minted new memories that will be                                       campowaissabauer.com
shared for generations to come. Getting to today was no
easy feat, and I am thankful for your trust and willingness to participate again in WeBeLoS Woods this year.
This year’s theme is Follow Your Scouting Compass. Just as you lead your Scouts here, from first verbal memos,
adventure loops and pins, to rank completion, this weekend will put it all to application and readiness to make that
final crossover, departing the Cub Scout program on to greater horizons in Scouts BSA.
The transition from Cub Scouts to Scouts BSA is one full of excitement. A child’s mind is filled with lofty dreams,
adventure, and hope. As our youth sharpen their leadership skills, they will learn how to follow, becoming more
aware that their compass serves a greater purpose than geographical navigation. In your final efforts as their Den
Leader, consider using the E.D.G.E. method (Explain, Demonstrate, Guide, Enable) to help guide your WeBeLoS
Scouts on to a troop in Scouts BSA.
The primary purpose of this outing is to:
    •   Network – WeBeLoS Scouts, Scouts, leaders and parents share and bond,
    •   Showcase – WeBeLoS Scouts and Scouts showcase their training and skills,
    •   Exemplify – See others and share part in the meanings of being a Scout,
    •   Transition – Finalize a WeBeLoS Scout’s plans for continuing on the path toward Eagle, and
    •   Serve – Serve God and one another.
Secure your spot by registering on Council’s website today. All attendees must register via Council’s website,
https://sfcbsa.org/events/everglades-webelos-woods. Whether you are a Den Leader, WeBeLoS Scout, parent,
family member attending the crossover ceremony, or volunteer (troops, crews, OA, etc.), your registration helps
safeguard the limited capacity enforced by the County law enforcement. Unfortunately, anyone not registered for
this event will be turned away.
Assisting me as Master of Ceremonies during the day on Saturday, April 17 is Michelle Ballinger, Past Chief and
all-around great friend. As my Scouting Compass would have it, I have a schedule conflict on this day that cannot
be moved. Our Planning Committee is top-notch, and I greatly appreciate their many efforts to make this event an
awesome experience for you and your Scouts. If there is anything we can do to help you prepare for this event,
please call me at (502) 445-4728 or send an e-mail to webeloswoodseverglades@gmail.com. See you on the trail.
In God We Trust

Chris Zavatsky
Chief, WeBeLoS Woods 2021

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LEADER GUIDE SFC Everglades District
SFC Everglades District                                                                                                          WeBeLoS Woods 2021

TABLE OF CONTENTS
1.0 INTRODUCTION .............................................................................................................................................. 1-1
     1.1 YOU WANT TO BE HERE ......................................................................................................................... 1-1
     1.2 EVENT LOCATION .................................................................................................................................... 1-1
     1.3 SAFETY FIRST – WE CAN DO THIS ........................................................................................................ 1-1
2.0 EXPECTATIONS BEFORE AND DURING THE EVENT ................................................................................ 2-1
     2.1 PLANNING COMMITTEE CONTACTS ..................................................................................................... 2-2
3.0 ORDER OF OPERATION ................................................................................................................................ 3-3
     3.1 REGISTRATION ........................................................................................................................................ 3-3
     3.2 CHECK-IN PROCEDURES ....................................................................................................................... 3-3
     3.3 SCHEDULE OF EVENTS / ACTIVITIES ................................................................................................... 3-4
           3.3.1 DEN ROTATION SCHEDULE .......................................................................................................... 3-6
           3.3.2 GATEWAY / COLORS DISPLAY ..................................................................................................... 3-6
           3.3.3 CAMPSITE EVALUATION ............................................................................................................... 3-6
           3.3.4 SCOUT’S OWN ................................................................................................................................ 3-6
           3.3.5 AWARDS CEREMONY .................................................................................................................... 3-6
           3.3.6 CLOSING CEREMONY.................................................................................................................... 3-6
     3.4 CHECK-OUT PROCEDURES ................................................................................................................... 3-7
4.0 MISCELLANEOUS........................................................................................................................................... 4-8
     4.1 WEBELOS WOODS 2022 ......................................................................................................................... 4-8
     4.2 INFORMATION / LOST AND FOUND ....................................................................................................... 4-8
     4.3 UPCOMING COUNCIL AND DISTRICT EVENTS .................................................................................... 4-8
     4.4 WEBELOS WOODS PAST CHIEFS .......................................................................................................... 4-8

LIST OF TABLES
Table 2-1.      AOL Scout Information for Crossover Ceremony ................................................................................ 2-1
Table 2-2.      WeBeLoS Woods Planning Committee Contacts ................................................................................ 2-2
Table 3-1.      Fee Structure and Availability .............................................................................................................. 3-3
Table 3-2.      Schedule of Events / Activities ............................................................................................................. 3-5
Table B-1.      Campsite Evaluation Scoresheet ........................................................................................................ 4-5
Table B-2.      Gateway Evaluation Scoresheet ......................................................................................................... 4-6
Table B-3.      Knots Scoring Sheet............................................................................................................................ 4-9
Table B-4.      Tug-O-War Check-In Sheet............................................................................................................... 4-17

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LEADER GUIDE SFC Everglades District
SFC Everglades District                                                                                                WeBeLoS Woods 2021

LIST OF FIGURES
Figure 1-1. Camp Owaissa Bauer Location .......................................................................................................... 1-2

APPENDICES
APPENDIX A. POLICY, REQUIREMENTS, AND HEALTH FORMS
     A.1 BSA FORM 680-001
     A.2 BSA FORM 680-057
     A.3 SOUTH FLORIDA COUNCIL COVID QUESTIONAAIRE
APPENDIX B. RULES OF ENGAGEMENT
     B.1 GROUND RULES
     B.2 CAMPSITE EVALUATION CRITERIA
     B.3 GATEWAY EVALUATION CRITERIA
     B.4 ACTIVITIES / COMPETITIONS
          B.4.1 Knots (hosted by Troop 10)
          B.4.2 First Aid Leap Game (hosted by __________)
          B.4.3 Stretcher Race (hosted by Troop 23)
          B.4.4 Scavenger Hunt with GPS Coordinates (hosted by ______)
          B.4.5 Scouts BSA Jeopardy (hosted by _________)
          B.4.6 Chariot Races (hosted by ____________)
          B.4.7 Skit/Songs (hosted by _________)
          B.4.8 Tug-O-War (hosted by _____________)
     B.5 AWARDS
     B.6 CAMPFIRE DO’S AND don’tS
APPENDIX C. NAVIGATION
     C.1 CAMP OWAISSA BAUER MAP
APPENDIX D. LEADER AND VOLUNTEER RESOURCES
     D.1 ADULT LEADER CRACKER BARREL
     D.2 WEBELOS WOODS BRIDGE
     D.3 CROSSOVER CEREMONY SCRIPT
     D.4 SATURDAY NIGHT CAMPFIRE / CROSSOVER CEREMONY

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SFC Everglades District                                                               WeBeLoS Woods 2021

ACRONYMS/ABBREVIATIONS

 Acronyms/Abbreviations   Definition
 AOL                      Arrow of Light
 BSA                      Boy Scouts of America
 Crew                     Venturing is an inclusive program through the Boy Scouts of America for males
                          and females aged 14 - 21 (or 13 and completed the 8th grade). It's operated
                          through Venturing Crews, units of youth and advisors that meet on set schedules
                          and plan activities and events for youth like you!
 Council                  South Florida Council, serving Broward, Miami-Dade, and Monroe Counties.
                          The program of the Boy Scouts of America is administered through 253 local
                          councils, with each council covering a geographic area that may vary from a
                          single city to an entire state. Each council receives an annual charter from the
                          National Council and is usually incorporated as a charitable organization.
 Den                      A small group of Cub Scouts who are the same gender and in the same grade.
                          The ideal size is 6 to 8 Cub Scouts. Den Leaders, usually a parent, serves as a
                          Den Leader.
 District                 Everglades District, serving all units geographically located in Miami-Dade
                          County south of Coral Way.
 Evergladeer
 O.A.                     The National Honor Society of the Boy Scouts of America, composed of Scouts
                          and Scouters who best exemplify the Scout Oath and Law in their daily lives as
                          elected by their peers.
 Patrol                   A team of normally six to eight members where Scouts learn skills together,
                          share responsibilities and take on leadership roles. THE PATROL METHOD. As
                          a member of a patrol, youth are afforded opportunities that are hard to find
                          anywhere else.
 Ship                     Sea Scout units – called ships – are established all across the country on
                          oceans, bays, rivers, and lakes. They provide limitless opportunities and exciting
                          challenges that you won't find anywhere else. Sea Scouts is a place to grow and
                          learn, find adventure, and build long lasting friendships
 Troop                    Scouts BSA is the traditional Scouting experience for youth in the fifth grade
                          through high school. Service, community engagement and leadership
                          development become increasingly important parts of the program as youth lead
                          their own activities and work their way toward earning Scouting’s highest rank,
                          Eagle Scout.
 Unit                     Any of the following: Crew, Pack, Ship, Team, or Troop
 WeBeLoS                  We’ll Be Loyal Scouts
 YPT                      Youth Protection Training

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SFC Everglades District                                                             WeBeLoS Woods 2021

1.0 INTRODUCTION

Welcome to WeBeLoS Woods 2021. This year’s event will be held at Camp Owaissa Bauer north of
Homestead. Camp will open Friday, April 16th at 1700 and conclude Sunday, April 18th by 1300.

1.1 YOU WANT TO BE HERE
WeBeLoS Woods completes your scouting year in mid-April with a variety of competitions for WeBeLoS
Scouts to apply the knowledge and skills they have learned in their advancements and service projects.
The competitions are administered by volunteer units such as Scouts BSA troops, Venturing Scout crews,
and Order of the Arrow members demonstrating the best that scouting has to offer.
                                  This is where WeBeLoS Scouts who have earned the Arrow of Light, the
                                  highest rank in the Cub Scouting program, compete one last time for
                                  their pack before taking part in the Crossover Ceremony on Saturday
                                  night. Make sure to invite family and friends as they will not want to miss
                                  this moving ceremony.

1.2 EVENT LOCATION
Located at 17001 SW 264th Street, Homestead, Florida, Camp Owaissa Bauer is owned by Miami-Dade
County and operated by the Parks, Recreation, and Open Spaces (PROS) Department. Figure 2-1
provides a marker for the location.
Park Description
Come and explore one of Miami-Dade County Park's hidden treasures, Camp Owaissa Bauer, special
activity area of the Miami-Dade County Parks, Recreation and Open Spaces Department, is designed for
large-group camping and is located near Homestead, Florida. It is complete with buildings and facilities to
accommodate a total of 160 cabin campers and up to 200 tent campers for overnight and extended period
camping. The camp is available to organized groups up to one year in advance by contacting the Camp
Manager's office.

1.3 SAFETY FIRST – WE CAN DO THIS
Nothing has been more routine in planning this event than thinking of your safety and those with whom you
will come into contact after this event. With more than a year since the COVID-19 pandemic began, a new
understanding has evolved regarding Scout Law No. 11. Please review all of Appendix A to familiarize
yourself with the procedures for attending this event. I do not believe you will find anything to be
unrecognizable, but it is important that we uphold the regulations so everyone can mint joyous memories.

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SFC Everglades District                                             WeBeLoS Woods 2021

                          Figure 1-1. Camp Owaissa Bauer Location

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SFC Everglades District                                                             WeBeLoS Woods 2021

2.0 EXPECTATIONS BEFORE AND DURING THE EVENT

Expect to contact the WeBeLoS Woods Planning Committee before the event with any ‘special needs
and/or concerns’ (i.e. accessibility for handicapped participants, issues with storage pod, etc.).
Expect to review and understand this Leader Guide thoroughly and ask questions in a timely manner.
Expect that this leader guide will be updated multiple times prior to the start of the event. Changes will be
issued identifying content removed and content added. Look for the date of issue in the lower-right corner
of each sheet (i.e. 022821).
Expect that Camp Owaissa Bauer will open on Friday, April 16th at 1700 for check-in. The crew leader
must check in and will receive the campsite assignment at that time. Please inform your WeBeLoS Scouts’
parents that they cannot individually check-in and they CANNOT just drop their child off and leave. All
WeBeLoS Scouts must be supervised at all times by a minimum two adults, one of which being current on
their Youth Protection Training (YPT).
Expect that ALL UNITS MUST check in at the Registration Site in order to:
            1. Finalize registration counts and payments (you must have proof of payment).
            2. Register your crews and receive their rotation assignments and armbands.
Expect zero vehicular access to the campsites with one exception to vehicles towing trailers. Motor
vehicles may park in the southeast corner of the property where directed by volunteer staff. The distance
between the parking area and the camping area is just over one football field in length. We are expecting
many WeBeLoS Scouts and Scouters to attend the event and we want to provide a safe environment for
all. Trailers will be allowed to remain in the unit’s designated campsite. Campers and Volunteers bringing
trailers are to request vehicular entry in writing by Friday, April 9th by sending an e-mail to
WeBeLoSWoodsEverglades@gmail.com.
Expect that no vehicles will be allowed to park at the campsite, all vehicles must be parked in the
designated parking area. The interior parking lot is designated for staff and handicapped parking.
Expect that each Unit should be prepared to cook their own meals.
Expect that the boys and girls will not complete any “Adventure” this weekend.
Expect to adhere to the rules and order of operations. Respect all persons and the roles they serve.
Expect to provide the information in Table 3-1 regarding your Arrow of Light (AOL) Scouts for the bridge
crossover.

                       Table 2-1. AOL Scout Information for Crossover Ceremony

  Den Leader         AOL Scout          Pack No.          Crossing to        Patrol        Scoutmaster’s
    Name               Name                               Troop No. /       Leader’s          Name
                                                          Patrol Name        Name

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SFC Everglades District                                                              WeBeLoS Woods 2021

Expect that, due to limited capacity, County law currently prohibits exceeding a maximum of 250 people at
Camp Owaissa Bauer at any one time. Also restricted is the number of people that can register for and go
camping; no more than 80 people may camp at this event. All attendees are to register for this event via
https://sfcbsa.org/events/everglades-webelos-woods. Early bird rates will expire on at the end of March 26
and all registration will close at the end of April 9. All attendees includes WeBeLoS Scouts, parents,
Planning Committee staff, Volunteers, day-goers, campfire visitors, and anyone else not identified that will
step foot on this property during this event must register.
Expect that Volunteers are comprised of Troops, Crews, and Order of the Arrow members. They, along
with the WeBeLoS Woods planning committee members, deserve our praise and appreciation for aiding in
the success of this event. Volunteers are recognized in this book where aid is being received. I encourage
your Scouts to meet with all of them. We are strengthened by the bonds built and kindled by every one of
us. Be sure to share part in this.
Expect that all Troops in Everglades District are invited to set up a demonstration or display at this event.
Expect that all Scouts, regardless of rank, are expected to wear the complete Class A uniform during all
camp-wide gatherings at the flagpole.
Expect that ‘Leave No Trace’ begins with you. Be the example for others and ask them to help pick up
along the way. Everyone will help! This will allow your checkout procedures to go smoothly. �

2.1 PLANNING COMMITTEE CONTACTS
All written correspondence should be sent to the WeBeLoS Woods 2021 Planning Committee at
webeloswoodseverglades@gmail.com. Table 3-2 provides a list of key contacts before, during, and after
WeBeLoS Woods 2021.

                       Table 2-2. WeBeLoS Woods Planning Committee Contacts

                               Title                   Name                Contact
                              Chief               Chris Zavatsky       (502) 445-4728
                            Asst. Chief          Michelle Ballinger    (305) 582-0895
                          Medicine Man               Dan Wall          (305) 546-5942
                           Evergladeer               JD Anson          (305) 297-9731
                           Evergladeer           Beatrice Martinez     (305) 799-6399
                           Evergladeer              Anna Brown         (305) 725-9377
                           Evergladeer              Jeff Jacobs        (305) 519-6132
                           Evergladeer             Linda Fredrick      (305) 302-8611
                           Evergladeer            Michelle Jacobs      (305) 281-1118
                     Advisor / Administrator       Peggy Durbin        (305) 364-0020
                            Executive               Jeff Berger        (305) 364-0020

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SFC Everglades District                                                                  WeBeLoS Woods 2021

3.0 ORDER OF OPERATION

3.1 REGISTRATION
All persons attending this event are REQUIRED to register in advance through the South Florida
Council website, https://sfcbsa.org/events/everglades-webelos-woods. Due to limited space and
increased safety regulations, advance registration secures your place for attending this event.
As of this draft, the County will allow up to 250 people on the property for this event. No more than 80
people can stay overnight for camping. Approximately 150 people will be able to register for the day and
campfire. The event will be run by approximately 90 volunteers.
Be sure to provide an email and phone number where we can contact you. We will be following up on
groupings and photo releases.
Family members and younger Cub Scouts will NOT be admitted except for attending the campfire and
crossover ceremony. This is an event for WeBeLoS Scouts only, supported in person by parents, leaders,
and volunteers.
Fees
With the exception of volunteers, every attendee must pay the registration fee to enter the property. The
fee structure and availability for registration is presented in Table 4-1.

                                    Table 3-1. Fee Structure and Availability

          Registration Type               Early Bird Rate1           Regular Rate2          Spots Available3
       Youth Camper – 2 Nights                    $25                     $35
                                                                                                     80
        Adult Camper – 2 Nights                   $25                     $35
     Youth Day / Campfire Attendee                $10                     $15
                                                                                                     80
     Adult Day / Campfire Attendee                $10                     $15
               Volunteer                          $0                       $0                        90
1.    Registration deadline is end of day on March 26, 2021.
2.    Registration deadline is end of day on April 9, 2021.
3.    Limited capacity at Camp O.B. is subject to change without communication from the Committee.

No walk ups will be accepted this year. We will be very structured with the specific scouts and number,
please make sure your Scouts and parents register as soon as possible.
Any questions or special arrangement needs should be emailed to webeloswoodseverglades@gmail.com
and Peggy.Durbin@scouting.org.

3.2 CHECK-IN PROCEDURES
Check-in times are scheduled for Friday evening from 1700 to 2200 and will run throughout Saturday from
0700 to 2100.
Prior to arrival, attendees will need to update their medical forms and e-mail to
webeloswoodseverglades@gmail.com. On the day of arrival, all attendees must submit their BSA health

                                                        3-3                                               030121
SFC Everglades District                                                           WeBeLoS Woods 2021

check forms for check-in. Additionally, all attendees must complete a temperature check before they may
proceed to the parking area. Vehicles may only go to the parking area and nowhere else. Appendix A
provides copies of the medical and health check forms needed.
Figure 3-1 provides a map of the vehicular path when entering the park to complete health screenings and
check-in.
All attendees will be placed into groups of up to 10 people. This will be your “Den” for the weekend and
you are not to co-mingle with other dens.

3.3 SCHEDULE OF EVENTS / ACTIVITIES
Table 3-2 provides a complete schedule of events and activities for the duration of the weekend.

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SFC Everglades District                                                                          WeBeLoS Woods 2021

                                             Table 3-2. Schedule of Events / Activities

 Day / Time                                      Description                                        Report to:
                1700 – 2200                      Check-In Procedures                                Main Gate
                1700                             Main Gate is open                                  Main Gate
                1900 – 2100                      Dinner and campsite setup                          Camp Area
     Friday

                1700 – 2200                      Gateway building                                   TBD
                2200                             Cracker Barrel (adult leaders and den chiefs)      TBD
                2200                             Taps / Quiet time
                2200                             Main Gate is closed
                2300                             Lights out
                0630                             First Call / Reveille
                0630                             Breakfast                                          Camp Area
                0630 – 0800                      Gateway building                                   TBD
                0700 – 2100                      Check-In Procedures                                Main Gate
                0800                             Opening Ceremony                                   Flagpole
                0900 – 1200                      Activities                                         Parade Field /
                0900 – 1000                      Gateway inspections                                TBD
                1200 – 1300                      Dinner                                             At last activity
                1245                             Afternoon instructions                             Flagpole
     Saturday

                1300 – 1400                      Campsite Inspections                               Camp Area
                1300 – 1600                      Activities                                         Parade Field /
                1630                             Tug-O-War Showdown                                 Parade Field
                1700 – 1830                      Supper                                             TBD
                1745 – 1930                      Scout Cast Iron Chef Dessert Competition           TBD
                1930 – 2000                      Torchlight parade                                  Trails
                2000 – 2100                      Campfire / Bridging Ceremony / Closing             TBD
                2100 – 2200                      Daytime attendees disperse
                2200                             Cracker Barrel (adult leaders and den chiefs)      TBD
                2200                             Taps / Quiet time
                2200                             Main Gate is closed
                2300                             Lights out
                0630                             First Call / Reveille
                0630                             Breakfast                                          Camp Area
                0800                             Scout’s Own                                        Fire ring
     Sunday

                0830                             Morning flag, awards ceremony, dismissal           Flagpole
                0900                             Break camp                                         Camp Area
                1000                             Checkout Procedures                                Camp Area /
                1200                             Depart Camp Owaissa Bauer1                         Main Gate
1.          With appropriate discharge papers.

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SFC Everglades District                                                             WeBeLoS Woods 2021

3.3.1 DEN ROTATION SCHEDULE
To be announced.

3.3.2 GATEWAY / COLORS DISPLAY
All Units must build a wooden gateway entrance to the Unit area. The gateway must include a flagpole,
which will fly the flags of the United States of America and your Pack flag. More than one flagpole and flag
is allowed.
Gateways are YOUTH MADE – make the gateway manageable by the youth in the unit. Adults may not
give help or guidance with the gateway.
Cub Scout gateways should be high enough for the WeBeLoS Scouts to pass through. A 2- foot area next
to the gateway will be allowed as side entrance for the adults in the unit.
NO HOLES WILL BE PERMITTED.

3.3.3 CAMPSITE EVALUATION
All units that will be camping are to participate in this event and show everyone that your Pack can set up
a model campsite. For reference, a sample layout is provided which meets current regulations for physical
separation and food preparation.
WeBeLoS Woods volunteers will evaluate the campsites. Visitations may occur at any time within the
allotted time for inspection on Saturday. You are encouraged to keep your campsite in tip top condition.
The reviewers will be evaluating the campsites based on the criteria included in Appendix D.
Packs may use “low impact” camping methods such as fire extinguishers rather than fire buckets. Fire
suppression devices should be placed at a minimum in the camp kitchen / cooking area and in an easily
accessible area of the campsite. Two fire buckets per tent may be substituted.
In true Scout patrol style, there should be a separate kitchen for each color band (den) area.
Please encourage your WeBeLoS Scouts to utilize the patrol method during this event so that they can
further practice the methods of Scouts BSA.

3.3.4 SCOUT’S OWN
Be there in l be Class “A” uniform.
Attendance is mandatory. Immediately following the Scouts’ Own, we will proceed with the Closing
Ceremony and the presentation of awards.

3.3.5 AWARDS CEREMONY
Details forthcoming.

3.3.6 CLOSING CEREMONY
There will be no checkouts or departures prior to the conclusion of the closing ceremony.
Additional details forthcoming.

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SFC Everglades District                                                            WeBeLoS Woods 2021

3.4 CHECK-OUT PROCEDURES
In order to ensure an orderly check out process, please observe the following guidelines:
    •   The same rules that were followed on Friday night for vehicles in the campsite will be in effect.
        Only one vehicle at a time in the campsites. Your cooperation will ensure that no one gets hurt
        during this hectic period.
    •   Do not begin to take your campsite down until AFTER the Closing Ceremony is complete. No one
        will be allowed to check out until after the Closing Ceremony.
    •   After your campsite is dismantled and all gear and trash has been removed, request a campsite
        inspection at the registration area. Once your campsite is approved, bring the passcode to
        registration to receive your check out packet.
    •   All trash must be placed in the dumpster or taken out. Please flatten all boxes, water jugs, or any
        other bulky materials. In other words, “Smash that Trash”. PLEASE, no broken tents, gateway
        materials or skit props in the dumpsters…we don’t have the room.
    •   In the event that the dumpsters are full, please be prepared to haul your garbage out of the
        campgrounds. No garbage will be left behind.
    •   NO GARBAGE MAY BE PLACED ON THE OUTSIDE OF THE DUMPSTERS AND THE LIDS
        AND SIDE DOORS MUST BE PROPERLY CLOSED.

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SFC Everglades District                                 WeBeLoS Woods 2021

4.0 MISCELLANEOUS

4.1 WEBELOS WOODS 2022
To be announced.

4.2 INFORMATION / LOST AND FOUND
Lost and found will be located at the flagpole.

4.3 UPCOMING COUNCIL AND DISTRICT EVENTS

4.4 WEBELOS WOODS PAST CHIEFS

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SFC Everglades District                                                                WeBeLoS Woods 2021

APPENDIX A. POLICY, REQUIREMENTS, AND HEALTH FORMS

Last updated September 22, 2020, this Council policy may be amended as new guidance is issued by our
state, local governments, and healthcare experts. The following is a summary of Council’s most recent
COVID-19 policy following the Florida and County Department of Health information.
Groups of 10 or fewer participants are now permissible for activities if the sanitization and other guidelines
are followed. Groups of 10 or fewer participants are now permissible for overnight camping. Multiple
groups may attend that do not co-mingle.
Participants with significant health conditions are free to participate in events that comply with the guidelines
in this policy provided, the volunteer has a current physical with BSA Form 680-001 Parts A, B and C
completed (see section near the end of this policy entitled “Vulnerable Populations”).
Council, District, or Unit Activities and Events
    1. While many businesses and other events are opening, we continue to encourage districts and units
       to hold activities virtually. However- you may meet in person.
    2. If a Council, District, or Unit meeting or event cannot be effectively held on a remote basis or if an
       “in person” meeting is preferable, such activities or events can occur if all the following requirements
       are followed:
            a. A maximum of ten Participants may gather together in one group.
            b. For clarity, more than ten Participants may attend a meeting or event.
            c. All groups with a maximum of ten Participants must be at least six feet from all other groups.
            d. Inside the group of ten or less, each individual should maintain the social distancing
                requirement.
            e. The scout professional and the Council, District or Unit volunteer in charge of the meeting
                must ensure that the social distancing requirement is followed.
            f. The six-foot requirement for groups can be briefly ignored when multiple Participants are
                arriving or if a transition is required.
            g. For example, it may take a few minutes to separate Participants into different groups that
                are six feet apart.
            h. Please do not use this as an excuse to willfully ignore the social distancing
                requirement.
            i. Set up check-in lanes that allow for Participants to maintain a six-foot gap.
            j. When forming groups of ten or less, youth protection policies apply — including two deep
                leadership, age, and gender of youth, etc.
    3. The Council, District or Unit volunteer in charge of the meeting or event (or his or her designee)
       must sanitize high touch areas before the meeting or event begins.
            a. For example, doorknobs, tables, and other areas that are regularly touched must be wiped
                down and disinfected prior to the arrival of others.
            b. If a bathroom will be used, the bathroom must also be disinfected- sanitized before the
                arrival of others.
            c. Sanitation efforts will need to be coordinated with the organization that is allowing use of
                its facilities.
                       i. Adults should be in charge of sanitation efforts.
                      ii. If a youth or youths will be sanitizing, adult Participants, following youth protection
                           policies, should supervise the sanitation efforts.
                     iii. The Council or District volunteer in charge should ensure hand sanitizer or other
                           hand washing supplies are available.

                                                                                                        030121
SFC Everglades District                                                              WeBeLoS Woods 2021

                   iv. Do NOT assume the facility will have these supplies.
   4. Handshakes or other, person to person contact should not occur.
   5. Avoid sharing any tools or equipment among attendees (e.g., sign-in sheets, clip boards and pens
      that are passed from person to person).
   6. Facial covering or masks MUST be worn.
   7. Participants with any COVID-19 symptom may not attend the meeting or event.
          a. If within the prior 14 days an attendee has been in contact with anyone with these
               symptoms, the attendee may not attend the meeting or event.
          b. Prior to entering the meeting or event area, the Council or District volunteer in charge or
               the scout professional in attendance, (or his or her designee) should ask this question orally
               to all participants or hand out a written COVID Questionnaire Form each attendee asking
               these same questions.
          c. COVID-19 symptoms include temperatures greater than 100.4 degrees, cough, shortness
               of breath, difficulty breathing, or other respiratory symptoms or at least two of the following
               symptoms: chills, repeated shaking with chills, muscle pain, headache, sore throat, or new
               loss of taste or smell.
          d. If the event or meeting is scheduled to last more than four hours, each attendee should
               have his or her temperature taken with an infrared thermometer upon arrival at the meeting
               to ensure no one in attendance has a fever over 100.4 degrees.
          e. Avoid bringing food to these activities. Otherwise, the Council, District or Unit volunteer
               must ensure all food related requirements are followed provided by the Department of
               Health. Pay particular attention to Safe Food Handling. Food preparation staff should use
               masks and gloves. Minimize all those in contact with preparing food. Avoid cross
               contamination. Use Grab and Go Meals prepared when possible. Avoid Buffet or Family
               Style serving. Encourage cooking and eating of meals within the group size of ten.
          f. The Council, District or Unit Participants should have masks, gloves and other personal
               protective equipment available and as appropriate to the function and location of the
               meeting or event.
                     i. For example, at a Pinewood Derby event where a few people are checking in all
                        participants, such Participants may be provided masks and gloves if available and
                        if deemed appropriate. It is best to request that each person is asked to provide
                        their own personal protective equipment
Unit Camping or Approved Overnight Activities
   1. Individual units may hold overnight camps of less than 72 hours. These camps may be held at the
      Council owned or leased properties and other approved facilities.
   2. Unit camping must be carefully structured to avoid being classified as a summer camp or overnight
      summer camp. A summer camp is defined as “any entity offering organized sessions of supervised
      recreational, athletic or instructional activities held between school terms. An “overnight summer
      camp” is any summer camp where attendees remain overnight at the camping
      facility. Substantially, more restrictive sanitation and other requirements apply to overnight summer
      camping and to summer camps. For example, current COVID-19 testing is required for all
      participants in outdoor summer camps. (This designation does not pertain to your weekend
      camping events).
   3. To ensure social distancing requirements, we are reducing the maximum capacity at our Council
      camps effective June 12, 2020 through November 10, 2020. During this time, the maximum
      capacity at each camp and at each campsite within the camp is reduced by 50%. Reservations
      must be made by contacting Cliff Freiwald at Cliff.Freiwald@Scouting.org.

                                                                                                      030121
SFC Everglades District                                                               WeBeLoS Woods 2021

   4. Units using the Council’s camps must adhere to the following requirements. We realize this list is
       lengthy. The list is derived from the mandates we are required to follow. Please follow these
       requirements when camping so we can have a safe environment available for a unit’s overnight
       camping.
   5. As part of making a reservation to camp, the unit leader is agreeing to follow all provisions of this
       policy and is responsible for ensuring others follow the policy. If a until leader has any questions
       about the policy, please contact your district executive or other scout professional.
   6. Groups can only have a maximum of ten Participants. Multiple groups may share a campsite and
       facilities at our Council camps provided each group is at least six feet from all other groups.
            a. For example, a Troop with 35 scouts and adult Participants can share the same
                 campground composed of three or more groups (each comprised of 10 or fewer
                 Participants) if there is sufficient room for each group to be at least six feet apart from all
                 other groups. Once a group is formed, absent an emergency or other unexpected event,
                 the group should remain as a group the entire campout (i.e., no exchanging Participants
                 among groups).
   7. Events held during the unit campout must not result in a gathering of more than ten Participants
       within six feet of another group.
   8. Care must be taken during other gatherings such as a flag raising or lowering, patrol or den events,
       camp events, free time, scoutmaster minutes, etc. If unit leaders are not able to maintain social
       distancing at all times, the unit leader should end the overnight campout immediately.
   9. When forming groups of ten or less, youth protection policies apply — including two deep
       leadership, age, and gender of youth, etc. At camp, the buddy system still applies. Buddies must
       be part of the same group.
   10. The six-foot requirement for groups can be briefly ignored when multiple Participants are arriving
       or a group is in transit.
            a. For example, one group can pass another group on a camp trail. However, no lingering
                 should occur. Please do not use this as an excuse to willfully ignore the social
                 distancing requirement.
   11. At the beginning of each day, the unit leader or his or her designee must remind all campers of the
       social distancing requirements and hand washing guidelines.
   12. The unit leader (or his or her designee) must assume sanitizing obligations for the campground
       and the camp facilities that are used.
            a. Do not assume tents or other sleeping structures provided by any camp facility are
                 sanitized.
            b. Similarly, leaders cannot assume restrooms or other camp buildings are sanitized.
   13. Leaders must arrange for sanitizing supplies that will be used by all campers during the event or
       campout. DO NOT assume the camps will have sufficient sanitation supplies.
   14. Leaders should encourage Participants to bring their own hand sanitizer or other hand washing
       supplies. Regardless, leaders of the campout should plan well in advance to ensure adequate
       hand washing is available for all participants.
            a. Unit leaders should remind and encourage all participants to wash their hands for at least
                 twenty seconds multiple times each day.
            b. Handwashing must occur after use of any restroom facility and during snack breaks or
                 meal breaks.
   15. Leaders must completely sanitize bathrooms each morning with at least one additional sanitizing
       effort every 4 hours during the day and at other times as necessary. Overnight sanitization between
       11PM and 6 AM is not required.
            a. Leaders must sanitize high touch areas and surfaces during the day.
            b. Sanitation efforts can be coordinated with other units using the camp.

                                                                                                       030121
SFC Everglades District                                                                 WeBeLoS Woods 2021

               c. Adults should be in charge of sanitation efforts.
               d. If youth will be sanitizing, adult Participants should supervise the sanitation efforts. Please
                   follow youth protection protocols. Handshakes, or other, person to person contact is
                   prohibited.
               e. Facial covering or masks are required unless you may distance over twenty feet from one
                   another. Unit leaders should ensure all participants provide their own face covering
   16.   Masks are not optional – wear them.
   17.   It is recommended that each participant in the campout should have his or her temperature taken
         using infrared (no touch) thermometers.
               a. Unit leaders or parents/guardians should take temperatures before leaving for camp.
               b. Additional temperature testing may occur each morning and each evening. Participants
                   with a fever over 100.4 degrees or who exhibit symptoms of COVID-19 will not be allowed
                   to remain in camp.
               c. COVID-19 symptoms include temperatures greater than 100.4 degrees, cough, shortness
                   of breath, difficulty breathing, or other respiratory symptoms or at least two of the following
                   symptoms: chills, repeated shaking with chills, muscle pain, headache, sore throat, or new
                   loss of taste or smell.
               d. Unit leaders must prepare a quarantine area where scouts or other Participants who show
                   symptoms of COVID-19 can remain separate from all others until a parent or other
                   individual can drive the scout home.
                         i. Any individual exhibiting COVID-19 symptoms must be separated from the group
                            immediately and must leave camp as soon as possible.
                        ii. Youth protection protocols apply at all times.
   18.   Prior to a campout and again when leaving for the campout, the unit leader must communicate to
         each parent or guardian of a scout attending the campout and to each adult volunteer attending
         the campout that the scout or adult is NOT permitted to attend the campout if they have been
         diagnosed with COVID-19, have exhibited symptoms of COVID-19 or had contact with a person
         that has or is suspected of having COVID-19 within the past fourteen days.
   19.   Parents or guardians dropping off or picking up youth must remain in their cars.
               a. To the extent practicable, unit leaders should establish staggered drop off and pick up
                   times.
               b. Hand sanitizer should be provided to youth and volunteer adults, at the drop location, if
                   practicable.
               c. Unit Leaders should pre-screen each participant prior to departing for the campout to
                   ensure no participant is displaying symptoms of COVID-19.
   20.   Unnecessary visitors should not visit the unit during the campout.
   21.   Do not use camp facilities that you cannot regularly sanitize or ensure have been sanitized. Do not
         have person to person interaction with other units camping at the same campground.
               a. Sanitize shared facilities regularly.
   22.   Each camper’s belongings should be stored separately (e.g., in their tent).
               a. Belongings should not be commingled.
               b. Discourage sharing of items such as flashlights, camp tools, etc.
               c. Do Not over crowd tents or sleeping facilities. One person per tent is always preferable
                   unless it is family members from the same home
   23.   To the extent possible, allow only one group at a time to use camp equipment.
               a. Sanitize the camp equipment after such use and before the use by another group.
               b. If the unit permits swimming (following all swimming guidelines of the camp and of the
                   BSA), each group may swim only once each day. Swimming times should be staggered
                   to avoid crowding at the swimming location.

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SFC Everglades District                                                             WeBeLoS Woods 2021

            c. If a unit vehicle is used to transport youth or a parent transports other youth in addition to
               their own, the vehicles must be sanitized before and after each use.
            d. The unit leader should provide masks, gloves and other personal protective equipment as
               available and as appropriate to the function and location of the Participants.
            e. For example, if an adult leader were required to temporarily interact with multiple groups
               of campers, that leader should be provided or use their own personal protective equipment
               (such as a mask) when interacting with the other groups.

YouTube link for COVID Camping Information
https://www.youtube.com/watch?v=cOfgFDr8QT8

Health Forms
All attendees will need to complete the following forms ahead of their arrival.

    1. BSA Form 680-001 – Medical forms
    2. BSA Form 680-057 – Model COVID-19 Pre-Event Medical Screening Checklist
    3. South Florida Council COVID Questionnaire

Item 1 is to be submitted to and reviewed by the den leader. Items 2 and 3 are to be hand-delivered at
check-in.

A copy of each form is provided under this appendix for your convenience.

                                                                                                     030121
SFC Everglades District   WeBeLoS Woods 2021

A.1 BSA FORM 680-001

                                      030121
Part A: Informed Consent, Release Agreement, and Authorization                                                                                                                                                   A
Full name: ____________________________________________                                                                      High-adventure base participants:
                                                                                                                             Expedition/crew No.:________________________________________________
Date of birth:__________________________________________                                                                     or staff position:____________________________________________________

Informed Consent, Release Agreement, and Authorization

I understand that participation in Scouting activities involves the risk of personal injury, including          I also hereby assign and grant to the local council and the Boy Scouts of America, as well as their
death, due to the physical, mental, and emotional challenges in the activities offered. Information             authorized representatives, the right and permission to use and publish the photographs/film/
about those activities may be obtained from the venue, activity coordinators, or your local council.            videotapes/electronic representations and/or sound recordings made of me or my child at all
I also understand that participation in these activities is entirely voluntary and requires participants        Scouting activities, and I hereby release the Boy Scouts of America, the local council, the activity
to follow instructions and abide by all applicable rules and the standards of conduct.                          coordinators, and all employees, volunteers, related parties, or other organizations associated
                                                                                                                with the activity from any and all liability from such use and publication. I further authorize the
In case of an emergency involving me or my child, I understand that efforts will be made to                     reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said
contact the individual listed as the emergency contact person by the medical provider and/or                    photographs/film/videotapes/electronic representations and/or sound recordings without limitation
adult leader. In the event that this person cannot be reached, permission is hereby given to the                at the discretion of the BSA, and I specifically waive any right to any compensation I may have for
medical provider selected by the adult leader in charge to secure proper treatment, including                   any of the foregoing.
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                  Every person who furnishes any BB device to any minor, without the express or implied permission
medical staff, camp management, and/or any physician or health-care provider involved in                        of the parent or legal guardian of the minor, is guilty of a misdemeanor. (California Penal Code
providing medical care to the participant. Protected Health Information/Confidential Health                     Section 19915[a]) My signature below on this form indicates my permission.
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,           I give permission for my child to use a BB device. (Note: Not all events will include BB devices.)
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.                                                 Checking this box indicates you DO NOT want your child to use a BB device.
(If applicable) I have carefully considered the risk involved and hereby give my informed consent                                 NOTE: Due to the nature of programs and activities, the Boy Scouts of
for my child to participate in all activities offered in the program. I further authorize the sharing                             America and local councils cannot continually monitor compliance of program
of the information on this form with any BSA volunteers or professionals who need to know of                                      participants or any limitations imposed upon them by parents or medical
medical conditions that may require special consideration in conducting Scouting activities.                                      providers. However, so that leaders can be as familiar as possible with any
                                                                                                                                  limitations, list any restrictions imposed on a child participant in connection with
With appreciation of the dangers and risks associated with programs and activities, on my                                         programs or activities below.
own behalf and/or on behalf of my child, I hereby fully and completely release and waive
any and all claims for personal injury, death, or loss that may arise against the Boy Scouts                    List participant restrictions, if any:                                None
of America, the local council, the activity coordinators, and all employees, volunteers,
related parties, or other organizations associated with any program or activity.                                ________________________________________________________

  I understand that, if any information I/we have provided is found to be inaccurate, it may limit and/or eliminate the opportunity for participation in any event or activity. If I am participating at
  Philmont Scout Ranch, Philmont Training Center, Northern Tier, Sea Base, or the Summit Bechtel Reserve, I have also read and understand the supplemental risk advisories, including height
  and weight requirements and restrictions, and understand that the participant will not be allowed to participate in applicable high-adventure programs if those requirements are not
  met. The participant has permission to engage in all high-adventure activities described, except as specifically noted by me or the health-care provider. If the participant is under the age of 18, a
  parent or guardian’s signature is required.

  Participant’s signature:_____________________________________________________________________________________________ Date:_______________________________

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

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

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

Name: __________________________________________________________________                                        Name: __________________________________________________________________

Phone: __________________________________________________________________                                       Phone: __________________________________________________________________

Adults NOT Authorized to Take Youth to and From Events:

Name: __________________________________________________________________                                        Name: __________________________________________________________________

Phone: __________________________________________________________________                                       Phone: __________________________________________________________________

                                                                                                                                                                                                                 680-001
                                                                                                                                                                                                             2019 Printing
Part B1: General Information/Health History                                                                                                                                 B1
Full name: ____________________________________________                                                         High-adventure base participants:
                                                                                                                Expedition/crew No.:________________________________________________
Date of birth:__________________________________________                                                        or staff position:____________________________________________________

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

Address:__________________________________________________________________________________________________________________________________________

City:____________________________________________State:_____________________________ ZIP code:___________________                          Phone:_______________________________

Unit leader:_____________________________________________________________________________ Unit leader’s mobile #:__________________________________________

Council Name/No.:________________________________________________________________________________________________________Unit No.:_____________________

Health/Accident Insurance Company:_________________________________________________________ Policy No.:____________________________________________________

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

In case of emergency, notify the person below:

Name:_______________________________________________________________________________Relationship:____________________________________________________

Address: __________________________________________________________________ Home phone:__________________________ Other phone:__________________________

Alternate contact name:__________________________________________________________________ Alternate’s phone:_______________________________________________

Health History
Do you currently have or have you ever been treated for any of the following?
  Yes      No                                 Condition                                                                             Explain
                  Diabetes                                                              Last HbA1c percentage and date:                            Insulin pump: Yes £ No £

                  Hypertension (high blood pressure)
                  Adult or congenital heart disease/heart attack/chest pain (angina)/
                  heart murmur/coronary artery disease. Any heart surgery or
                  procedure. Explain all “yes” answers.
                  Family history of heart disease or any sudden heart-related
                  death of a family member before age 50.
                  Stroke/TIA

                  Asthma/reactive airway disease                                        Last attack date:

                  Lung/respiratory disease

                  COPD

                  Ear/eyes/nose/sinus problems

                  Muscular/skeletal condition/muscle or bone issues

                  Head injury/concussion/TBI

                  Altitude sickness

                  Psychiatric/psychological or emotional difficulties

                  Neurological/behavioral disorders

                  Blood disorders/sickle cell disease

                  Fainting spells and dizziness

                  Kidney disease

                  Seizures or epilepsy                                                  Last seizure date:

                  Abdominal/stomach/digestive problems

                  Thyroid disease

                  Skin issues

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

                  List all surgeries and hospitalizations                               Last surgery date:

                  List any other medical conditions not covered above

                                                                                                                                                                                  680-001
                                                                                                                                                                              2019 Printing
Part B2: General Information/Health History                                                                                                                                                     B2
Full name: ____________________________________________                                                         High-adventure base participants:
                                                                                                                Expedition/crew No.:________________________________________________
Date of birth:__________________________________________                                                        or staff position:____________________________________________________

Allergies/Medications
DO YOU USE AN EPINEPHRINE                    YES       NO                                               DO YOU USE AN ASTHMA RESCUE                   YES       NO
AUTOINJECTOR? Exp. date (if yes) ___________________________                                              INHALER? Exp. date (if yes) ___________________________________

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

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

                   Medication                                                                                            Plants

                   Food                                                                                                  Insect bites/stings

List all medications currently used, including any over-the-counter medications.
 Check here if no medications are routinely taken.                             If additional space is needed, please list on a separate sheet and attach.
                   Medication                             Dose                     Frequency                                                              Reason

    YES     NO            Non-prescription medication administration is authorized with these exceptions:_________________________________________________________________
Administration of the above medications is approved for youth by:
_______________________________________________________________________ /________________________________________________________________________
                                      Parent/guardian signature		                                                    MD/DO, NP, or PA signature (if your state requires signature)

           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.

Immunization
The following immunizations are recommended. Tetanus immunization is required and must have been received within the last 10
years. If you had the disease, check the disease column and list the date. If immunized, check yes and provide the year received.          Please list any additional information about your
                                                                                                                                           medical history:
  Yes      No       Had Disease                           Immunization                                    Date(s)
                                                                                                                                           _________________________________________
                                      Tetanus
                                                                                                                                           _________________________________________
                                      Pertussis
                                                                                                                                           _________________________________________
                                      Diphtheria
                                                                                                                                           _________________________________________
                                      Measles/mumps/rubella

                                      Polio                                                                                                 DO NOT WRITE IN THIS BOX.
                                                                                                                                            Review for camp or special activity.
                                      Chicken Pox
                                                                                                                                            Reviewed by:____________________________________________
                                      Hepatitis A
                                                                                                                                            Date:__________________________________________________
                                      Hepatitis B
                                                                                                                                            Further approval required:    Yes            No
                                      Meningitis
                                                                                                                                            Reason:________________________________________________
                                      Influenza
                                                                                                                                            Approved by:_____________________________________________
                                      Other (i.e., HIB)
                                                                                                                                            Date:__________________________________________________
                                      Exemption to immunizations (form required)

                                                                                                                                                                                                    680-001
                                                                                                                                                                                                2019 Printing
Part C: Pre-Participation Physical
This part must be completed by certified and licensed physicians (MD, DO), nurse practitioners, or physician assistants.
                                                                                                                                                                                                       C
Full name: ____________________________________________                                                             High-adventure base participants:
                                                                                                                    Expedition/crew No.:________________________________________________
Date of birth:__________________________________________                                                            or staff position:____________________________________________________

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

Please fill in the following information:
                                              Yes    No                                                                         Explain

 Medical restrictions to participate

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

                    Medication                                                                                            Plants

                    Food                                                                                                  Insect bites/stings

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

                           Normal         Abnormal         Explain Abnormalities                Examiner’s Certification
                                                                                                I certify that I have reviewed the health history and examined this person and find no contraindications for
 Eyes                                                                                           participation in a Scouting experience. This participant (with noted restrictions):

                                                                                                   True         False                                           Explain
 Ears/nose/throat
                                                                                                                        Meets height/weight requirements.

 Lungs                                                                                                                  Has no uncontrolled heart disease, lung disease, or hypertension.
                                                                                                                        Has not had an orthopedic injury, musculoskeletal problems, or orthopedic
                                                                                                                        surgery in the last six months or possesses a letter of clearance from his or her
 Heart                                                                                                                  orthopedic surgeon or treating physician.
                                                                                                                        Has no uncontrolled psychiatric disorders.
 Abdomen
                                                                                                                        Has had no seizures in the last year.

                                                                                                                        Does not have poorly controlled diabetes.
 Genitalia/hernia
                                                                                                                        If planning to scuba dive, does not have diabetes, asthma, or seizures.

 Musculoskeletal
                                                                                                Examiner’s signature:________________________________________ Date: ________________

 Neurological                                                                                   Examiner’s printed name:__________________________________________________________

                                                                                                Address:________________________________________________________________________
 Skin issues
                                                                                                City:_______________________________________State:_______________ ZIP code:__________
 Other                                                                                          Office phone:____________________________________________________

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

   Height (inches)            Max. Weight             Height (inches)             Max. Weight              Height (inches)           Max. Weight                 Height (inches)           Max. Weight
          60                        166                      65                       195                          70                     226                             75                   260
          61                        172                      66                       201                          71                     233                             76                   267
          62                        178                     67                        207                          72                     239                             77                   274
          63                        183                     68                        214                          73                     246                             78                   281
          64                        189                     69                        220                          74                     252                      79 and over                 295

                                                                                                                                                                                                      680-001
                                                                                                                                                                                                  2019 Printing
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