August 2011 Allergy and Medical Information All new students are required to submit a Physician's Report form. For returning students, parents are required to inform the school if there is a change in the medical status. Both new and returning students are required to complete the attached form. So that staff members can identify students who might require immediate intervention on site and take appropriate action, we ask that you include a current photo of your son with this form. If your son requires medication (e.g. Epipen or antihistamine) in case of exposure to or consumption of some specific food and /or exposure to or contact with some substance or organism, you should send two sets of medication to the Elementary / Middle School Assistant. One will be kept in the office on the third floor of Lucas (Gr. 1-8) and one will be kept in the Front Office across from the Dining Room. Please do not assume that we have medication from last year. Most things have expired, and your authorization is necessary in order to treat the student. All medication should be clearly labelled with the student's name and instructions for use.
Transportation Information
In order to ensure the safety of your child, the school should know what your child's regular method of transport to and from school will be.
The attached form should be returned to the Elementary-Middle School Assistant (K-8) no later than September 14, 2011.
TO BE COMPLETED BY PARENT OR GUARDIAN EACH SCHOOL YEAR
In case of an emergency, the school staff will contact 911.
Every attempt will be made to contact a parent, guardian, or a designated emergency contact.
Part 1: PARENT OR GUARIAN TO COMPLETE. Student Name: __________________________________________________________ Grade: _______ My child has a medical condition that may affect his school day: NO
_______________________________________________
_______________________________________________
Part 2: COMPLETE ALL BOXES THAT APPLY TO YOUR CHILD. Parent or Guardian is responsible for providing the school with any medication. ALLERGIES
Food List food(s) _______________________________________________ Bee sting Other (list) ____________________________________________________
Other _______________________________________
Currently prescribed treatments to be used IN SCHOOL:
Other _______________________________________
Currently prescribed treatments to be used IN SCHOOL: DIABETES Currently prescribed treatments to be used IN SCHOOL:
Other medication(s) List medication(s) _______________________________________________
OTHER HEALTH CONDITIONS
Other (explain) ___________________________________________
Medication needed IN SCHOOL: No Yes List medication(s) ___________________________________ Special Procedures: No Yes Explain __________________________________________________________ TRANSPORTATION 2011-2012
In order to ensure the safety of your child, the school should know what your child's regular method of transport to and from school will be. Student's name: __________________________________ Grade: ___________ Method of transportation to school and person responsible: ___________________________________________________________________ Method of transportation from school and person responsible: ____________________________________________________________________
Nebulisers Nebulisers You should only use a nebuliser if your doctor has advised you to do so. This information sheet is designed for people already using a nebuliser and is only intended to be used as a guide. You should always discuss the use of your medicines with your doctor or nurse. A nebuliser is a powerful drug delivery system. It should only be used if your doctor has
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