Gail Willie, RN, Health Center Manager Mary K. Fry, RN, NP, School Nurse 301-774-7455, ext. 120 (or 141) channel 5 of the 2 way radios gail.willie@ssfs.org, Mary.Fry@ssfs.org

2010-2011 Forms Now Available:

2010-2011 Health Forms Packet - Day Students

2010-2011 Health Forms Packet - Resident Students

NOTE: You will need Adobe Acrobat Reader to view and print these forms. Click here to download this free software if it is not already installed on your computer.

Dear Parents and Guardians,

Above you will find links to the medical forms for the 2010-2011 school year. All forms except the Medication Order Form are due in the Health Center by July 1, 2010. Please complete the forms in black ink only, and do not staple the forms together.

 The Medical Emergency Form must be filled out each year for all students. Please indicate any student allergies, any health conditions, and any medications taken by the student, whether given at home or at school, on this form. Please ensure that your complete address is listed, contact phone numbers are up-to-date, and the form is signed and dated.

All new students, students entering 3rd grade, all Middle and Upper School students, and students with pre-existing health conditions, must have a current Physical Exam Form on file. Middle and Upper School student athletes without current physicals on file will be excluded from all practices and games.

 Maryland State law requires all students to be up to date with their immunizations. If immunizations are not up to date by October 2, 2010 the child will not be allowed to attend school. A Meningococcal vaccine will be required for all dorm students.

A Medical History Form is included for all students. This form must be completed once and will be kept in the student’s file to provide baseline health data.

If your child will be taking prescription medication at school, state law requires theMedication Order Form be completed by a physician, nurse practitioner or dentist. A parent/guardian signature is also required on this form. The medication must be brought to the school nurse by a parent or guardian in the original prescription bottle with the completed Medication Order Form. The student’s name, medication name, dosage, and times of administration listed on the bottle MUST match the Medication Order Form in order for school personnel to legally administer the medication to your child.

 If you have any questions concerning the Health Forms, please contact the Health Center at (301) 774-7455 x199 or x141..