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Health Form Preschool Academy (one per student)

Please complete the form below. Required fields marked with an asterisk *

PARENTS:  Please complete the following health information form one for each child.  It is very helpful for the teachers and the school office to be aware of any health problem that your child may have.  Please feel free to use the comment box at the end of the form should you need more room to explain. 

Please put a check mark beside any items which pertain to your student.  

Does your student have allergies:*
Answer Required

-----Allergies------

Food Allergies
Answer Required
Environmental Allergies
Answer Required
Bee Allergies
Answer Required
Allergy Medications taken by your student
Answer Required

-----Asthma------

Does your student have Asthma?*
Answer Required

-----Diabetes------

Does your student have Diabetes?*
Answer Required
Which Type of Diabetes?
Answer Required

-----Food Intolerances------

Does your student have Food Intolerances?*
Answer Required

-----Nose Bleeds------

Does your student have Nose Bleeds?*
Answer Required

-----Migraines------

Does your student get Migraines?*
Answer Required

-----Seizures------

Does your student have seizures?*
Answer Required

-----Fainting Spells------

Does your student have fainting spells?*
Answer Required

-----Other------

Hospital Preference*
Answer Required
I hereby give Blackhawk Christian School, its administrators, nurse, teachers, staff and/or any hospital personnel, permission to do what they deem necessary for my child's well-being in the case of any emergency that might arise while he/she is at the school or participating in any school related function.*
Answer Required
Confirmation Email