2012 CAMP LEADER GUIDEBOOK - Black Hills Area Council

Unit Members Medical Insurance
Information Form
All Units attending summer camp MUST PROVIDE PROOF of Unit Accident Insurance.
(Proof would be a copy of your policy or a letter of insurance from your council.)
CIRCLE ONE: Insurance is for Unit - or - Insurance is provided by Council
Unit Number: Council Name:
Policy Holder’s Name:
Policy Holder’s Address:
City: State: Zip:
Policy Number:
Company Name:
Company Address:
City: State: Zip:
Additional Information:
This form can be turned in when you check-in at camp.
All leaders and all youth must have a current BSA Medical/Health form filled out and ready
to turn-in at camp check-in. They will be returned at check-out.
I state that the above information is correct.
Signed by a Unit Leader Date