Health & Medical Form — Troop TX-1333

Fill out your family’s official Trail Life Health & Medical forms online. Enter the shared family information once, add each Trailman (and any adult who needs a form), sign electronically, and download the completed official PDFs.

Your health information stays on your device. The PDFs are generated right in your browser — nothing is uploaded anywhere by the Download buttons.
The signature lines on the printed form stay blank so you can sign in ink when a physical copy is required (district or region events).
You’ll also get a small answers file — keep it, and next season upload it below to pre-fill everything.
Using a shared or public computer? Remember the downloads land in its Downloads folder — move and delete them when finished.

Returning family? Load last season’s answers file:

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Family Information entered once, used on every form

Home & contacts

Street address *

City *

State *

ZIP *

Family phone *

Mother’s name

Phone

Father’s name

Phone

Other emergency contact if parents cannot be reached

Name *

Relationship

Phone

Insurance

Family has health care coverage No health care coverage at this time

Insurance company #1

Policy #

Policy holder

Group #

Effective

Insurance card — front

Insurance card — back

Card photos are used when saving to troop records (and you should still attach a copy when handing in a printed form).

Care providers

Primary care physician *

Phone

Address, city, state, zip

Dentist

Phone

Address, city, state, zip

Preferred hospital

Adults authorized to take your Trailmen to and from events at least one; applies to all Trailmen below

Adults NOT authorized leave blank if none

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Your Trailmen & Adults

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Sign & Download

I give permission for full participation in Trail Life USA activities except where limited in the notes; this information is correct and complete to the best of my knowledge; I give permission for Trail Life USA leadership to administer prescribed and over-the-counter medications; in an emergency where I cannot be reached, I give permission to the licensed healthcare provider selected by Trail Life USA adult leaders to secure proper treatment, and I agree to the release of records necessary for treatment. I understand this record is valid for 12 calendar months, and that typing my full legal name below constitutes my electronic signature.

Electronic signature — type your full legal name *

This season’s troop code *

Printed in the troop announcement email — ask troop leadership if you don’t have it. (Only needed for saving; downloads work without it.)

Required — this files your family’s completed form(s) and insurance card photos directly with the troop’s protected Health & Safety records. No printing needed; only troop leadership can see them. Saving takes about 10–20 seconds. Made a correction? Just save again — the troop’s copy is replaced with your latest.

Family Information entered once, used on every form

Home & contacts

Other emergency contact if parents cannot be reached

Insurance

Care providers

Adults authorized to take your Trailmen to and from events at least one; applies to all Trailmen below

Adults NOT authorized leave blank if none

Your Trailmen & Adults

Sign & Download

Your own copies