Woodsville Elementary School Health Information
New Student (1st-3rd)
First & Last Name of Child: *
Please list any serious illness, allergy or disability *
Emergency Procedures:
Does your child take daily medications? *
Medication permission form on file with the school nurse? *
If your child takes any medications, please list below current list of medications:
Please Note: All medications must be in original container, with the written doctor's note and brought into school by an adult. All inhalers must be kept in the nurse's office at all times.
Please list any immunizations your child had over the summer (if none, please state that) *
Does your child have health insurance? *
If your child does have health insurance, please list the provider:
Your child's doctor is: *
Phone number of your child's doctor: *
Your child's dentist is: *
Phone number of your child's dentist *
Date of completion of this form: *
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This form was created inside of School Administrative Unit # 23. Report Abuse