2025 Region One Leadership Training Conference Medical Form Instructions
DeMolay standards and state laws require accurate medical records for participants and staff. They are also critical to ensure timely, effective care should your DeMolay become sick or injured while at LTC. All participants MUST complete the the Medical Record form annually.
DeMolays may not remain at LTC without a completed medical form.
Email all downloaded forms and Insurance Card to DeMolayRegionOneLTC@gmail.com
Read the medical Checklist carefully. Please note the following:
Part A – NOW ONLINE (if you have not filled out the online form, CLICK HERE)!
Part B1 – NOW ONLINE (if you have not filled out the online form, CLICK HERE)!
Part B2 – contains information about medication and allergies. Please complete these sections carefully and accurately. The parents and health care professional must sign to authorize all medication including non-prescription medication. A separate vaccination and medical record may be substituted for Part B2 if desired, provided that it contains ALL of the information listed in Part B2. Click Here to download Part B2, C, and D-NH
Part C – the annual physical. This page MUST be completed and signed by the health care professional conducting the physical examination. A separate medical record my be substituted provided that it contains ALL of the information listed on Part C.
CLICK HERE to download Part B2, C, and D-NH
Part D-NH – This page provides permission to possess & use epinephrine auto-injectors and/or asthma inhalers. The DeMolay’s health care professional and the parent/guardian must sign the bottom of this page. This is required by NH state regulations.
CLICK HERE to download Part B2, C, and D-NH
Part E – NOW ONLINE (if you have not filled out the online form, CLICK HERE)!
Part F – NOW ONLINE (if you have not filled out the online form, CLICK HERE)!
Part G – A picture of your insurance card (front and back)
