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Health Information
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Parent/Guardian Name
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Student Name
*
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Student Grade - 2023/24 School Year
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Choose
K3
K4
k5
1
2
3
4
5
6
7
8
Vision concerns?
Yes
No
Clear selection
If yes, please explain
Your answer
Hearing concerns?
Yes
No
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If yes, please explain
Your answer
Allergies
If student has allergies, you must complete linked form
http://www.christkingparish.org/editoruploads/files/5140_2(c).pdf
. This form needs to be submitted to the office.
Your answer
Medications-prescription and non-prescription
If student takes any type of medication, you must complete linked forms
http://www.christkingparish.org/editoruploads/files/5140_2(a).pdf
. and
http://www.christkingparish.org/editoruploads/files/5140_2(b).pdf
. These forms need to be submitted to the school office. No student can carry any medication including aspirin on their person.
Your answer
Other Health Concerns
*
If there are no concerns, please type "none".
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