Health Form 2019/2020
Parent/Guardian Phone Numbers
Parent/Guardian Email addresses
Emergency contact other than parent/phone number
Health Insurance Provider
Family Doctor and phone number
Preferred hospital in case of emergency
Drug or environmental allergies or other health concerns
Persons who may pick student up.
If my child is complaining of pain or itchiness, gets a minor cut, or has an allergic reaction, this serves as written permission for my child to be given an age-weight appropriate dose by the school health officer:
Ibuprofen or acetaminophen
I also give permission for a paramedic to treat my child, and for my child to be transported by ambulance if an emergency situation occurs—even if a parent cannot be reached.
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