CVSD Registration: Life Threatening Health Conditions
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Email *
Student Last Name *
Student First Name *
Student Middle Name *
Date of Birth *
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Parent/Guardian first & last name *
Home/Cell Phone *
Parent/Guardian Email *
Please describe your child’s current health condition below. It is important that you keep the school informed of any changes in health or medication that would affect your child at school. If your child needs to take medication at school, please notify the school office. My child has NONE of the health concerns listed below:
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Life Threatening Conditions: If anything is checked as LIFE THREATENING, notify your school’s nurse immediately and obtain LIFE THREATENING paperwork from school office. This is REQUIRED PER RCW 28A.210.320 for attendance at school. Please check all that apply:
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Required
Special Health Care Planning: My child has special health care needs such as: wheelchair, tube feedings, catheter, intravenous tubes, eating and swallowing concerns*, or other.
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Health Conditions: Check any conditions that your child has:
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