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Student Health Information

In order for St. Andrew Catholic School to better attend to the needs of your child, we are requesting the following information on every student.

This form must be completed for every student.  If you have multiple children enrolled, please complete this form for each child.

If there are any updates during the school year, please be sure to let us know so we may make the changes accordingly.

Please complete the form below. Required fields marked *

Student Information

Grade*
Answer Required
Does your child take any (prescribed, over-the-counter, homeopathic, or other) medication regularly*
Answer Required
Is your child allergic to bee stings?*
Answer Required
If YES, is it life threatening?
Answer Required
Does your child have seasonal allergies?*
Answer Required
Is your child allergic to any medications?*
Answer Required
Does your child have food allergies?*
Answer Required
Is your child allergic to PEANUTS?*
Answer Required
Does your child wear glasses?*
Answer Required
If YES, please indicate the following
Answer Required
Does your child wear contact lenses?*
Answer Required
If YES, please indicate the following
Answer Required
Does your child have asthma?*
Answer Required
If YES, please indicate if it is Seasonal or PE induced
Answer Required
Will the medication(s) be kept in the clinic?
Answer Required
Does your child have nosebleeds?*
Answer Required
If YES, are the nosebleeds ...
Answer Required
I certify that the information provided above is accurate*
Answer Required
Confirmation Email