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Microsoft word - allergy&trans - k-8.doc

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:
____________________________________________________________________

Source: http://www.selwyn.ca/ftpimages/242/download/Heath%20&%20Transportation%20Information%20es.pdf

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