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