Health Alert. Does your child have any health condition that may affect participation in physical activities? Yes ___ No___. Limitations. (e.g. stair climbing ...
Parent preferred language of communication: Written:
Oral:
Home Telephone ( )
Work ( )
Cell ( )
Email:
Parent/Guardian(student resides with):
Relationship:
Address:
First Name:
Parent/Guardian:
Apt:
Home Telephone ( )
Work ( )
Cell ( )
Email:
Address:
Apt:
Borough:
Zip:
Zip:
Borough:
List below names of three (3) persons who may be called in case of an emergency or if child is sick in school. CHILD WILL BE RELEASED ONLY TO PERSONS NAMED ON THIS CARD. Name
Telephone ( )
Relationship
Name
Telephone ( )
Relationship
Name
Telephone ( )
Relationship
If there is a person who may NOT HAVE ACCESS to child, please indicate: Name
Relationship
Order of Protection Exists? Yes __ No__
Principal will be notified in writing of any changes to information on this card. Signature of Parent / Guardian
Today’s Date
IMPORTANT – PLEASE COMPLETE REVERSE SIDE OF THIS PAGE >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Grade
Class
Room No.
Teacher
HEALTH INFORMATION Name of Physician / Clinic:
Telephone ( )
Health Alert Does your child have any health condition that may affect participation in physical activities? Yes ___ No___ Limitations
(e.g. stair climbing, participation in gym)
Allergies
504 Services for the current year? Yes ___ No___ Previous year? Yes ___ No___ My child has (check any that apply): Private health insurance ____ ; Medicaid; ____ ; No health insurance ____ If “No health insurance,” are you willing to share contact information from this card to learn about insurance options? Yes ___ No___
If none of the named contacts can be reached, what do you wish the school to do if your child is sick or injured?
It is understood that in the final disposition of an emergency case, the judgment of the school authorities will prevail. The recommendation of the parents as indicated above will be respected as far as possible. Siblings: Last Name
First Name
School of Attendance
FOR SCHOOL USE…………………………………………………………………………………………………………………………………………………….. List below contacts made for emergency, illness or injury. Relevant records from Health Record.
Date
Contact
Reason
Disposition
TARJETA DE EMERGENCIA (Escriba en letra molde)
AÑO ESCOLAR 2016 – 2016
2do Nombre:
Zona Postal:
Zona Postal:
Estudiante: Appellido:
Fecha de Nacimiento:
Primer Nombre:
OSIS#:
Relacion:
Condado:
Oral:
Sexo:
Padre / Tutor (con quien reside el estudiante): Direccion:
Apt.
Idioma Preferido para comunicarse: Escrito:
Telefono de casa ( )
Trabajo ( )
Celular ( )
Correo electronico:
Direccion:
Apt.
Condado:
Padre / Tutor (con quien reside el estudiante):
Relacion:
Idioma Preferido para comunicarse: Escrito:
Oral:
Telefono de casa ( )
Trabajo ( )
Celular ( )
Correo electronico:
Direccion:
Apt.
Zona Postal:
Condado:
Si su hijo/a se enferma, nombre de tres (3) personas que podamos contactar en caso de emergencia. ESTUDIANTE PODRÁ SALIR SOLAMENTE CON PERSONAS NOMBRADES EN ESTA TARJETA. Nombre
Telefono ( )
Relacion
Nombre
Telefono ( )
Relacion
Nombre
Telefono ( )
Relacion
¿Existe Orden de Proteccion? Si __ No__
Persona que NO PUEDE ACERCARSE a su hijo/a: Nombre
Relacion
Es importante que notifique a la Directora por escrito de cambios en esta pagina. Firma de Padre / Tutor
Fecha de hoy
IMPORTANTE – POR FAVOR COMPLETE LA PARTE DE ATRAS DE ESTA PAGINA>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Grado
Clase
Salon
Maestro
INFORMACION SOBRE SALUD Nombre del Doctor / Clinica:
Telefono ( )
Alerta de Salud ¿Su hijo/a tiene alguna condicion de salud que le impida tener actividades? Si ___ No___ Limitaciones:
(por ejemplo, subir escaleras, clase de gimnasio)
Alergias:
¿Solicitó servicio de salud 504 para este año? Yes ___ No___ Previous year? Yes ___ No___ Si su hijo/a tiene (Marque uno): Seguro de salud privado ____ ; Medicaid; ____ ; No tiene seguro de salud ____ Si “No tiene seguro,” ¿nos permite compartir su informacion para saber mas acerca de seguro de salud? Si ___ No___
Si su hijo/a se enferma o se accidenta y no podemos ponernos en contacto con usted o sus personas en caso de emergencia, ¿que desea que la escuela haga?
Deseo que entienda que la disposicion final en el caso de una emergencia es a juicio de la autoidades escolares. La indicacion de los padres sera respectada lo mas possible. Hermanos: Apellido Primer Nombre Escuela donde asisten
PARA USO DE LA ESCUELA……………………………………………………………………………………………………………………………………….. Enumere a continuación los contactos realizados para la emergencia, enfermedad o lesión. Los registros pertinentes de registro de salud. Fecha
s c H o o L D 1 s T R l c T (770) 426—3300 - www.cobbk12.org. — 2016-2017 School Year Calendar - Option B. 514 G1 St t,M 'tt ,GA 30060. COBB COUNTY ...
1 ago. 2016 - It is the policy of Bosqueville ISD not to discriminate on the basis of race, ... Education Amendments of 1972; the Age Discrimination Act of 1975, ...
10 ene. 2018 - Students are failing to meet targeted reading levels and struggle with ... Schedule Academic Nights/Report Card nights on school calendar. 2.
19 oct. 2016 - information/clarification, please contact the high school principal or the .... en las areas disponibles de Texas Tech, Univerrsity of North Texas ...
through two base measures, including a parent survey or questionnaire, so that Title I ... Engagement programs through an annual evaluation of the program.
Articulos Escolares. Escuela Elementaria de Bishop 2017-2018. Kindergarten. •. Mochila con el nombre de su hijo. •. Toallitas de Cloro. •. Bolsas Ziplock de un ...
Phone: 780-998-2539. 9909 90 St Fort Saskatchewan. Su. M. Tu. W. Th. F. Sa. Su. M. Tu. W. Th. F. Sa. Su. M. Tu. W. Th. F. Sa. 1. 2. 1. 2. 3. 4. 5. 6. 7. 1. 2. 3. 4. 3.
First and Last Day of School. School Holiday. State Testing. Graduation: May 29, 2020. July 2020. Pewitt CISD. March 2020. April 2020. May 2020. June 2020.
6 feb. 2019 - Foot/toes. Functional. • Duck-walk, single leg hop ..... A concussion is a type of brain injury that changes the way the brain normally works.
Staff In-Service (No School for Students). School Resumes. Holiday (No School). Parent Meeting & Open House. Church Event (No School). First and Last Day ...
New Teacher Institute. Parent Conference/Student Holiday. Bad Weather Day. Staff Development. Early Release. First and Last Day of School. School Holiday.
New Teacher Institute. Parent Conference/Student Holiday. Bad Weather Day. Staff Development. Early Release. First and Last Day of School. School Holiday.
President's Day - No School. Aug 5-9. Teacher In Service (Student Holiday). Feb 26 ... Christmas Break - No School. Jun 5. Last Day ... August 2019. September ...