Stoneham Public Schools                              Annual Health Information                           2022-2023
Dear Parent/Guardian,

Please complete the information on this form and provide your electronic signature as requested. It is important that the school have up-to-date information to meet the needs of your child in the event of an emergency. All information will be kept confidential according to Massachusetts State Law. If you have any questions, feel free to call the Stoneham High School health office at 781-279-3810 x1317. This form will be sent directly to the Nurse at Stoneham High School.

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Email *
Student's Last Name *
Student's First Name *
Student's Date of Birth *
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Student's Grade *
COVID-19 Symptoms - if your child has any symptoms below, please contact your physician.  There is no COVID testing in school this year.  
❏ Fever (100° Fahrenheit or higher), chills, or shaking chills
❏ Cough (not due to other known cause, such as chronic cough)
❏ Difficulty breathing or shortness of breath
❏ New loss of taste or smell
❏ Sore throat
❏ Headache when in combination with other symptoms
❏ Muscle aches or body aches
❏ Nausea, vomiting, or diarrhea
❏ Fatigue, when in combination with other symptoms
❏ Nasal congestion or runny nose (not due to other known causes, such as allergies) when in combination with other symptoms

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