New Student Health Information: Single Student
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Student Health Form: Single Student
Student First Name
Student Last Name
Name of Person the person completing the medical information update.
List any allergies the student has.
List any special conditions the student has.
I give permission for my child to be administered the following over the counter medications provided by the school.
Ibuprofen (Advil, Motrin)
Diphenhydramine HCL (Benadryl)
Sore Throat Spray
Other, please specify
Doctor's Phone Number
Dentist's Phone Number