Permission To Treat
The following information must be completed by a parent or legal guardian. 
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Email *
Student's Name (last, first) *
Student's School *
Student's Grade *
Our school medical advisor has authorized all New Hartford Board of Education employed school nurses and substitute nurses to administer certain over the counter medications. Indicate below if you grant permission for employed school nurses and substitute nurses  to administer the these over the counter medications as needed. 
Nurse may administer the following over the counter medications as needed.
(burn gel/spray, aloe gel, antibiotic ointment, caladryl, calamine lotion, eye irrigation solution, petroleum jelly/aquaphor, hydrocortisone 1% cream, Tums, antiseptic wash)
 *
Required
Sunscreen Application Policy
Students six years of age or older are permitted to possess and self apply an over the counter sunscreen product while in school prior to engaging in any outdoor activity, with signed parent/guardian consent. A student's parent or guardian may submit a written note to the school nurse to allow their child to carry and apply sunscreen. 

If your child is under six years of age, a written doctor's order is required. The sunscreen must be provided from home and stored and applied in the nurse's office.
Benadryl &/or Epinephrine for Severe Allergic Reactions Policy
This emergency intervention is intended to protect the health and safety of students who may experience a life-threatening allergic response while at school. Symptoms of anaphylaxis may include, but are not limited to, difficulty breathing, swelling of the face or throat, hives, vomiting, or loss of consciousness. In such cases, immediate administration of epinephrine is the standard of care and may be lifesaving.

A student's parent or guardian may submit a written directive to the school nurse to prohibit the administration of epinephrine to such a student each school year. If you chose to do so, or have any questions, please contact your school nurse.

Please note that declining emergency treatment may significantly increase the risk of serious harm in the event of an allergic reaction. Families are encouraged to discuss any concerns with their healthcare provider and the school health office.

Name of Person Completing Form *
Relationship to Student (e.g. parent, legal guardian, foster parent ) *
Please contact your child’s school nurse if you have any questions and/or concerns.
A copy of your responses will be emailed to the address you provided.
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