Connecticut Technical High School System
Grasso Southeastern Technical High School
 
TELEPHONE (860) 448-0220, MAIN FAX (860) 446-9895, GUIDANCE FAX (860) 445-3862, NURSE'S FAX (860) 405-1856
Technologies

 Connecticut State Department of Education


HEALTH INFORMATION
FROM THE SCHOOL NURSE

 

Ann Dacek
Ann Dacek

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