healthforms

Below are the Jemicy Health Forms to be completed, as well as additional documentation to assist you in filling in the necessary information. Please note that all Health Forms are the same for both campuses.

Please use the following checklist to make sure your paper work is complete and returned to school prior to Thursday, August 15th, 2013. Click on the title of each form to download the file. We need these forms on file in order for your child to be permitted to participate in any extracurricular activities (such as athletics or field trips).

  • Immunization Record. For new students, a copy can be obtained from your pediatrician. For returning students, an updated record would be appreciated. Every student is required by law to have a record on file prior to the first day of school or they are not permitted in school.

  • Health Form. This document is mandatory for all students and should be returned prior to Thursday August 15, 2013.
    • Part I: Child’s history, emergency contacts, insurance information (to be filled out by parent);
    • Part II: Over-the-Counter Medications (to be filled out and signed by parent and physician);
    • Part III: Physical examination – a requirement for all new students and those students participating in after-school sports - (to be filled out and signed by physician). If this part of the form is not filled out, your child will not be allowed to participate in any after-school sports programs.
  • Prescription Medication Form. The form(s) (one order for each prescription medication needed) to be filled out by your physician and returned to the health center if:
    • student requires any medication to regularly be given during the school day
    • or medications normally taken at home will occasionally be given at school (if a dose is missed at home)
    If your physician needs to fax an order directly, the fax number for the Lower and Middle School is 410-653-1972; for the Upper School is 410-753-8085.

  • Overnight Trip Medication Form. These forms need to be filled out by your physician for middle and upper school students.

  • Allergy Action Plan.

Click HERE for additional suggestions in filling out the Health Forms. For any questions, please contact either school nurse listed below.

Pat Wheltle, RN & Melissa Kravet, RN

(410) 753-8015
School Nurses, Lower and Middle School

Ginny Ford, RN

(410) 753-8122
School Nurse, Upper School

Click HERE to fill out the Head Injury Information Form.