Student Travel Medical Form

Required

Must contain a date in M/D/YYYY format
Student's Namerequired
First Name
Last Name

Parent/Guardian Phone Numbers in Case of Emergency

Will your child require medication during this trip?

Medications currently stored in the Health Office and authorized by the student’s health care provider and parent authorization form will be sent on school trips. If additional medication is required, please provide the proper authorizations and medications per state regulations.

Should an emergency arise, your child will be transported to the nearest emergency facility and you will be notified as soon as reasonably possible.

Please provide email address of person submitting this form.
Must contain a date in M/D/YYYY format