Mandatory Health Screenings - Opt out Form 
The state of Massachusetts requires the following screenings to be completed by grade level:

Kindergarten - Vision and Hearing
1st Grade - Vision, Hearing, Height/Weight (BMI)
2nd Grade -Vision, Hearing
3rd Grade - Vision, Hearing
4th Grade - Vision, Hearing, Height/Weight (BMI)
5th Grade - Vision, Hearing, Postural Screening

For more information please go to https://www.mass.gov/lists/school-health-screening

I will be completing screenings throughout the year.  If you would like to opt your child out of a specific screening, please complete this form below by October 15th.  If you have multiple students, please complete a separate form for each child.  Thank you!
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Email *
Student's First Name *
Student's Last Name *
Date of Birth (Month, Day, Year) *
Grade
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Which screening would you like to opt your child out of? Check all that apply.  *
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I would like to speak with the school nurse about this.  (Please include your name and the best way to reach you)
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