Emergency Contact

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  • Student Information

  • NameSchoolGrade 
  • Guardians

  • Person to contact if parents are not available:
  • Health Information

  • Physical and Dental exams are required by the State. Your child will be given private forms to be filled by your doctor or dentist.
  • If these forms are not returned to us, we will schedule your child as follows:
    Physical Exams - Kindergarten or Grade 1, Grade 6, and Grade 11
    Dental Exams - Kindergarten or Grade 1, Grade 3, and Grade 7
    If your child is absent at the time of these exams, he/she will be scheduled the following year.
    ***Your signature below will give permission to do these exams.***
  • Please list any major health related issues we should be aware of.
    If your child has allergies or any physical problems, please indicate below.
  • DateReasonTreatment