June 2012

 

Dear Parents:

The following forms are required prior to the first day of school.

·         - Health Form pages 1 & 2 (Or your pediatrician’s standard form)

·        -  Emergency Information Form

The following form is needed only if your child needs any medication while in school (including over the counter medications such as Tylenol, Motrin, Xopenex and you must send in your own medication)

·         - Medication Permission Request

The following form is needed only if your child has food allergies and requires an Epi Pen in school:

·         - Emergency Treatment Epinephrine

 

Please mail completed forms to:

School Nurse - Lev Chana ECC

291 Meadowview Ave.

Hewlett Bay Park, NY 11557

 

Thank you for your cooperation. Have a great summer.  Everyone at Lev Chana looks forward to making your child’s next year at Lev Chana productive, happy and healthy!

 

Sincerely,

Nurse Pam

Lev Chana ECC Nurse

 

 

 

Health Form (page 1)

Health Form (page 2)

 

Emergency Information Form

 

Medication Permission Request

 

Emergency Treatment Epinephrine