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Statement of Health

This document is a student health form requiring parents to select an option regarding their child's health status in order to enroll in pre-K. The options are: 1) a health care professional has examined the child within the past year and found them able to participate; 2) a signed health care statement is attached; or 3) a medical affidavit is attached stating a diagnosis or treatment conflicts with religious beliefs. The form must be submitted within one week of the child beginning school.

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Mark McCoy
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55 views1 page

Statement of Health

This document is a student health form requiring parents to select an option regarding their child's health status in order to enroll in pre-K. The options are: 1) a health care professional has examined the child within the past year and found them able to participate; 2) a signed health care statement is attached; or 3) a medical affidavit is attached stating a diagnosis or treatment conflicts with religious beliefs. The form must be submitted within one week of the child beginning school.

Uploaded by

Mark McCoy
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Statement of Health

Student Name ____________________________ Date _______________

ADMISSION REQUIREMENT: All PreK students are required to submit this


form to the school office within one week of your child beginning school.

Please check only one option:

1. HEALTH-CARE PROFESSIONAL’S STATEMENT: I have examined


the above named child within the past year and find that he / she is
physically able to take part in the day care program.

______________________________________ ___________
Health Care Professional's Signature Date

2. A signed and dated copy of a health care professional’s statement is


attached.

3. Medical diagnosis and treatment conflict with the tenets and practices of
a recognized religious organization, which I adhere to or am a member
of; I have attached a signed and dated affidavit stating this.

______________________________
Parent Signature

____________________________
Date Submitted

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