Consent Form For Boy Scouts And Venture Group Physical Exam printable pdf download

Consent Form For Boy Scouts And Venture Group Physical Exam

Consent form for Boy Scouts & Venture Group

Physical Exam

I believe that Scouting helps teach discipline and keeps a person physically active.

More physical activity, sports and exercise are encouraged for a healthy lifestyle,

however they can on rare occasions, pose risks.

You might have heard on the news that there is a very rare chance of sudden

cardiac death during sports/physical activity. The risk of such an event is 1 in

200,000 to 1,000,000. It is very difficult to diagnose and prevent such an event. I

have reviewed some of the research studies done elsewhere. I also reviewed the

medical academies’ recommendations. I am providing the above info not to scare

you but to provide the information. To go an extra mile I am planning to include

one more history form on the top of regular scouting forms. It has a long list of

questions for which you have to check yes or no. If you answered yes for any of

the questions, please provide more info about that on a separate sheet of paper.

Happy and safe Scouting!!

Raghu Kasetty, MD

February 26, 2016

Consent

I understand that the scouting screening physical is provided free of charge by

volunteering physicians, assisted by nurses and others. I understand that this is a

onetime only, screening physical and doesn’t replace annual physicals with the

primary doctor. There is no physician-patient relationship beyond the day of the

physical. I understand that there are inherent risks with sports and physical

activities, including the one mentioned above in this page. By signing this form I

hereby relieve the legal liability on the personnel involved in performing the scout

physicals.

Parent Signature_________________________________Date________________

Scout Participant(18 yrs or older)____________________Date________________

Consent Form For Boy Scouts And Venture Group Physical Exam