Editing previous response:

Please fix the highlighted areas below before submitting.

Health History Form

Please complete the form below. Required fields marked with an asterisk *

Do you need an appointment with the school nurse?*
Answer Required
Do you give the school nurse permission to share pertinent health information with staff who come in contact with your child?*
Answer Required
I give permission for the following medications to be administered to my child during school: (check all that apply)*
Answer Required