* Required
I agree that the school nurse may share health information with appropriate school personnel to aid present and future educational decisions, and, if needed, make and distribute an emergency plan based on this information.
(For example: classroom teacher, para educator, lunchroom personnel, bus driver, or other staff as appropriate.)
Permission for Emergency Treatment
I give permission for release of information on this form for confidential use in meeting this student's health and educational needs in school. I understand that any changes regarding this student's health history need to be communicated to the school nurse/principal. I hereby authorize officials of the district to contact directly the person(s) named within this registration information and do authorize the named physicians to render such treatment as may be deemed necessary in an emergency for the health of the student. In the event that the parents/guardians or contact persons named in this registration cannot be contacted, the school officials are hereby authorized to take whatever action is deemed necessary in their judgment, for the health of the student. I will not hold the school district financially responsible for the emergency care and/or transportation of said student.
(This applies only to medically necessary treatment in the absence of a parent or guardian decision.)
Please provide an email address where we can send a link to your current form.