Student Life
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MEDICAL FORMS

 

It is school policy that all students have a physical examination by a licensed physician each summer before returning to school.  Please note that Pennsylvania State Law states that all immunizations must be up to date.  All medical forms must be completed and returned to Perkiomen by August 12, 2016. 

 All students are required to complete the following forms:

Consent for Medical Treatment

Physical Examination Form – signed by physician

Over the Counter (OTC) Medication Form

New students will need to complete the following forms:

Consent for Cognitive Testing and Release of Information (ImPACT testing) Athlete/Parent/Guardian Sudden Cardiac Arrest Symptoms and Warning Signs Information Sheet and Acknowledgement of Receipt and Review Form

If your child will have any medication administered at school, please complete the following:

Physician’s Medication Order  (one form for each medication – must be signed by physician)

Over the Counter Medication Release (one form for each medication – signed by parent)

If you have any questions about these forms or the Health Center, please feel free to contact our resident nurse, Esther Larimore (215-541-5065). 

Thank you for your assistance in completing these forms by the August 12, 2016 deadline.

THE PERKIOMEN SCHOOL
    |     200 Seminary st
    |     pennsburg, pa 18073
    |     215.679.9511
    |     contact us
   
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