Saint Catherine of Siena School – Health Forms 2017-2018
(Due July 1, 2017) Any questions, please contact our school nurse: Mrs. Colleen Kennedy 973-239-6968.
| Health Form | PLEASE DOWNLOAD ALL FORMS REQUIRED |
|---|---|
| Preschool 3 & 4 Health & Immun. | Required yearly for ALL NEW preschool 3 and 4 students. Requires a Physician’s signature & date. |
| Kindergarten Health & Immun. | Required for ALL kindergarten students. Requires a Physician’s signature & date. |
| Grades 1-5 Health & Immun. | Required for ALL NEW grade 1 through 5 students and recommended for current grade 4 students. Requires a Physician’s signature & date. |
| Grades 6-8 Health History Questionnaire – Pre-Participation Physical Examination – Immun. (Sport) | Required for all new and current 6 through 8 students who PARTICIPATE IN A SPORT at SCS. Requires a Physician’s signature. This form is valid for 365 days from the date of the physical examination. |
| OR | |
| Grades 6-8 Health & Immun. (NO Sport) | Required for ALL new grade 6 through 8 students and recommended for current grade 8 students who will NOT be participating in a sport at SCS. If you think you may want to participate in a sport please use the SPORT Pre-Participation form instead. Requires a Physician’s signature & date. |
| Immunization Record Form | An up-to-date immunization record is required for ALL students by NJ State Law. |
| Sudden Cardiac Death in Young Athletes Pamphlet AND Sudden Cardiac Sign Off Sheet | Required for ALL students who participate in a sport at SCS. Please sign. |
| Concussion Policy Acknowledgment Form | Required for ALL students who participate in a sport at SCS. Please read and sign. |
| Opioid Fact Sheets AND Opioid Sign Off Sheet | Required for ALL students who participate in a sport at SCS. Please read and sign. |
| Eye Injuries Pamphlet AND Eye Injury Sign Off Sheet | Required for ALL students.Please read and sign. |
| Authorization for exchange of confidential information | Required for ALL students. |
| Medication Administration Policy AND Medication Consent Form | Must be filled out – dated – signed by physician and parent. All medications ordered are only valid for the current school year. |
| Asthma Action Plan | Must be filled out – dated – signed by physician and parent. All medications ordered are only valid for the current school year. |
| Food Allergy Emergency Care Plan | Must be filled out – dated – signed by physician and parent. All medications ordered are only valid for the current school year. |
| Authorization to Self Administer for emergency medications only (EpiPen or Asthma Inhaler) | Must be filled out – dated – signed by physician and parent. All medications ordered are only valid for the current school year. |
| Food Allergy Information | Please read. |
| Head Lice Tips | Please read. |
