Nurse E-pass
In order to reduce the amount of students and reduce exposure to COVID-19, Please DO NOT SEND STUDENTS directly to nurse's office, complete this form and the nurse will call for them, unless a true emergency (broken bone, seizure etc.)
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Email *
STUDENT NAME *
Student ID *
TEACHER *
Grade *
Emergency? (ACTIVE SEIZURE, LIFE THREATENING ALLERGIC REACTION, SIGNIFICANT PHYSICAL INJURY, STUDENT PASSED OUT,ETC.) *
Required
Reason for visit: Check all that Apply *
Required
**FOR OTHER REASON-Brief description for need of nurse visit
Submit
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