* Required
Immunization Records must be up to date: DPT, HIB, Polio , MMR and Hep B. Please attach here.
If YES please provide details
Anaphylaxis If YES, please provide details
AllergiesIf YES, please provide details
SeizuresIf YES, please provide details
With your permission, the school nurse can administer the following without contacting you first. Should your child complain of minor pain or other problem while at school, the School Nurse will administer over-the-counter medications such as:
Tylenol/Panadol, Ibuprofen (non-aspirin)
Antacid tablets (for stomach)
Cough or sore throat lozenges/syrup
Benadryl (for allergies)
Topical ointment for rashes, etc.
I give permission to the school nurse to administer as listed above by electronic signature below.
1. in the event that my child becomes ill and needs to go home, it is my responsibility to arrange transportation for my child to be picked up at school.
2. I understand that my child will undergo health screenings by the school nurse.
3. I understand that in the event of a medical emergency, every effort will be made to notify parents/guardians as soon as possible.
4. I further consent to emergency procedures to be initiated in case of injury/accident or illness treatment of any sort deemed necessary, and I shall not hold him/her liable in a court of law.
Your electronic signature in the appropriate space below indicates that you agree to the terms of this application.
Please provide an email address where we can send a link to your current form.
2 College Green Avenue, Kingston 6, Jamaica 1-876-702-2070 • 1-876-702-2074