• Early Childhood Assessment Form (for children under 5 years old) (PDF)

• Dental Consent Form (Permission Form for Dental Services at School) (PDF)

• Health Assessment Record (PDF)

• Husky Information

• Medicine Administration Authorization

• Right to Refuse Epinephrine (Epi-pen) Treatment Form*

• School-Based Health Centers Registration Form (PDF)

*Public Act No. 14-176 regarding administration of an epi-pen as first aid to a student experiencing an allergic reaction. If you do not want an epi-pen administered as first aid to your child, please complete this form (in above link) and submit it to your child’s school nurse. Call Deb Chameides, Director of Nursing and Clinical Service, with any questions at 860-695-8760.