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2025-2026 Health Form (one per student Preschool and K-12 filled out yearly)

Health Form (completed yearly)

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. 

2025-2026 Student Grade Level*
Answer required for "2025-2026 Student Grade Level"

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

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

Does your student have allergies:*
(if no, skip ahead to the Asthma Section)
Answer required for "Does your student have allergies:"
Does your student have food allergies?*
Answer required for "Does your student have food allergies?"
Does your student have environmental allergies?*
Answer required for "Does your student have environmental allergies?"
Does your student have medication allergies?*
Answer required for "Does your student have medication allergies?"
Does your student have bee allergies?*
Answer required for "Does your student have bee allergies?"
Does your student have a latex allergy?*
Answer required for "Does your student have a latex allergy?"

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

Does your student have asthma?*
(If no, skip to Diabetes Section)
Answer required for "Does your student have asthma?"

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

Does your student have diabetes?*
(if no, skip to the Migraines Section)
Answer required for "Does your student have diabetes?"
Which type of diabetes?
Answer required for "Which type of diabetes?"

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

Does your student get migraines?*
(if no, skip ahead to Seizures Section)
Answer required for "Does your student get migraines?"

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

Does your student have seizures?*
(if no, skip ahead to Fainting Spells)
Answer required for "Does your student have seizures?"

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

Does your student have fainting spells?*
(if no, skip ahead to the Nose Bleed Section)
Answer required for "Does your student have fainting spells?"

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

Does your student have nose bleeds?*
(if no, skip ahead to the Food Tolerances Section)
Answer required for "Does your student have nose bleeds?"

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

Does your student have food intolerances?*
Answer required for "Does your student have food intolerances?"
Hospital Preference*
Answer required for "Hospital Preference"

-----Permission to Receive Over-the-Counter Medications -----

Each year, we have many students who come to the office with headaches, various discomforts, skin irritations, and minor injuries.  The office can only dispense medication with permission from the parents. Please sign below to give permission to dispense generic Tylenol, hydrocortisone cream and/or triple antibiotic ointment.

BCS has my permission for the above student to receive the following medication as needed during the school day:

Junior strength acetaminophen 160mg - Please indicate amount: (Does not apply to Pre-school)
Primary and Intermediate
Answer required for "Junior strength acetaminophen 160mg - Please indicate amount: (Does not apply to Pre-school)"
Regular strength acetaminophen 325mg - Please indicate amount: (Does not apply to Pre-school)
Intermediate
Answer required for "Regular strength acetaminophen 325mg - Please indicate amount: (Does not apply to Pre-school)"
Extra strength acetaminophen 500 mg - Please indicate amount: (Does not apply to Pre-school)
Secondary
Answer required for "Extra strength acetaminophen 500 mg - Please indicate amount: (Does not apply to Pre-school)"
Hydrocortisone Cream
Answer required for "Hydrocortisone Cream"
Triple Antibiotic Ointment
Answer required for "Triple Antibiotic Ointment"
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 for "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."

Blackhawk Christian School does not discriminate on the basis of race, color, sex, nationality, or ethnic origin in its admission, education, financial, or employment policies.

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