Medical Form 2018/2019

Please fill out ALL information below for ONE child per submission.

Or if you prefer to fill out a paper form, you can click this link below to access a PDF version: PDF Version of Medical Form

Additional Emergency Contacts

Medical History

NOTE: No student should have any medication not prescribed by a physician as according to school policy. If medication is needed while traveling, it must be accompanied by a note from the parent requesting that it be taken during this time. Also, medication must be in the original prescription bottle. The nurse or chaperone shall dispense with these medications as designated by the Director. It is the responsibility of the parent and/or student to advise of any changes.

Insurance

IF YOU OR THE EMERGENCY CONTACT CANNOT BE LOCATED IN CASE OF A SEVERE EMERGENCY, YOUR STUDENT WILL BE TRANSPORTED BY AMBULANCE TO THE NEAREST HOSPITAL.

Final Authorization

By digitally signing my name below, I agree to all the terms and conditions described on this web page.