HEALTH INFORMATION FROM THE SCHOOL NURSE
School Nurse - Ann Dacek Tel. (860) 448-0220 ext. 326 FAX (860) 405-1856 E-mail: Ann.Dacek@ct.gov
Forms (All forms are in Adobe Acrobat format. Download the FREE Adobe Acrobat Reader.)
SPORTS Important Information about Sports Physical Note: The Interscholastic Athletics Health History, Permission & Physician’s Release Form must be signed by both parent and student's medical provider. A copy of the most recent physical exam must also be attached and returned to the School Nurse. Interscholastic Athletics Health History, Permission & Physician’s Release Form GENERAL Health Assessment Record (HAR3) Immunization Record Medical Exemption Form Medicine Authorization Form Religious Exemption Form
HUSKY - Healthcare for Uninsured Kids and Youth