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Health Forms

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.
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.
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