Medical History (Elementary Only)
FOR NEW STUDENTS ONLY
Child's Name *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
HAS YOUR CHILD HAD OR HAVE (Check all that apply) *
Required
HIGH FEVER* How high? Cause?
Your answer
ALLERGIES (PLEASE LIST) *
Your answer
SKIN RASH DUE TO ALLERGIES? *
CHILD'S APPETITE *
DOES YOUR CHILD TAKE MEDICATION THAT WILL NEED TO BE GIVEN AT SCHOOL? *
IF YES TO ABOVE QUESTION, PLEASE LIST MEDICATION (N/A IF NONE) *
Your answer
WAS YOUR CHILD'S BIRTH WEIGHT NORMAL? *
CHILD'S BIRTH WEIGHT *
Your answer
ANY OTHER INFORMATION ABOUT YOUR CHILD THAT YOU FEEL IS NECESSARY FOR THE SCHOOL TO HAVE? *
Your answer
PARENT FE *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy