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California health history form

Girl scouts health history form 2026

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The document is a health history record for participants in the Girl Scouts of Northern California, requiring annual completion by a parent or guardian. It collects essential information about the girl, including personal details, emergency contacts, health conditions, allergies, medications, and immunization history. The document emphasizes the confidentiality of health information and outlines permissions for medical treatment in emergencies.

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Click ‘Get Form’ to open the Girl Scouts Health History form in the editor.
Begin with Part 1: Girl Record. Fill in your daughter’s name, birth date, school attending, and contact information for both parents. Ensure all fields are completed accurately.
Inquire about any special needs your daughter may have and provide details if necessary. Indicate whether you consent to emergency medical treatment.
Proceed to Part 2: Emergency Contact. Enter the name and phone numbers of an emergency contact other than a parent.
For Part 3: Insurance Information, fill in the names and contact details of your child’s doctor and dentist, along with insurance carrier information.
In Part 4: Allergies/Illnesses/Injuries, check applicable allergies and chronic illnesses. Provide additional details as needed.
Complete Part 5: Medications by indicating if your child is taking any medications and listing them along with possible side effects.
Finally, review the immunization history in Part 6, ensuring all entries are accurate before signing and dating the form at the end.

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What is the Girl Scout code?

Girl Scout Law Always tell the truth. Be nice to others and help when asked or when someone is in need. Stand up for what is right, and tell a trusted grownup when you see someone being hurt or bullied. If you say you will (or will not) do something, keep your promise!

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