Clinic Information Card 2023-2024
The information collected on this form will only be used for medical and safety purposes.  This form will replace the traditional index card which will no longer be given out.  The information will be confidential and only be shared with appropriate staff in emergency situations or situations needed for the care and safety of students.
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Email *
Student's Last Name *
Student's First Name *
Gender *
Date of Birth *
Grade *
Base School *
Name of Siblings enrolled in this school (If your child has no siblings, please type none.) *
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This form was created inside of Newton County Schools Georgia.

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