Emergency and

Medical Form

This information is considered confidential. To ensure the health and safety of your child, it will be shared with school staff as needed during the time your child is enrolled at Glacial Hills Elementary, unless you request otherwise in writing. Once again, this information is considered valid as long as your child is enrolled at GLacial Hills Elementary, unless you indicate otherwise in writing or by submitting a new online form submission.

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Parent|Guardian Information

Who does the student live with?

Emergency Contact Information

Health History & Medication

Has your child had any complaints of or treatment for any of the following? If yes to any, please describe details the following box. Also, pease notify th school if any changes occur in this information.

Non-apirin (acetaminophen or Tylenol) will be provided when necessary only in the case of low-grade fever. According to school policy, administration of ANY medication (prescription or over-the-counter) must be requested by written permission from the parent or guardian.

If any medication (prescription or over-the-counter) is to be given by school staff on a regular schedule, it must be brought to school in the original pharmacy container along with authorization signed by the parent and physician stating the time the medication is to be given and how long it is to be given. Please consult the student handbook for the complete medication policy adopted by the Board of Education.

Is your child taking any medications on a regular basis at... (check all that apply)

You have completed the last step for your child's registration. If you have multiple children who attend Glacial Hills, please complete the medical form for each one.