STUDENT INFORMATION: PERSONAL (To be completed by Parent)
MEDICAL EVALUATION: IMMUNIZATION RECORDS (To be completed by Parent)

Immunization Records must be up to date: DPT, HIB, Polio , MMR and Hep B. Please attach here.

Max file size: 10 MB
Asthma 

If YES please provide details

Anaphylaxis  
If YES, please provide details

Allergies
If YES, please provide details

Diabetes
If YES, please provide details

Seizures
If YES, please provide details

PERMISSIONS TO ADMINISTER MEDICATION

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.

PARENT AGREEMENT AND CONSENT

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.

ADDITIONAL INFORMATION: EMERGENCY CONTACT INFORMATION Parent will be called first

Physician

Dentist

Orthodontist


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.

Email Address :

2 College Green Avenue, Kingston 6, Jamaica
1-876-702-2070 • 1-876-702-2074

  
    
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