Student Health Form

1. Does your child have a health condition or diagnosis ?

2. Is your child on any medication(such as inhalers)?

3.Does your child have any allergies?

4.Does your child have any difficulty with speech and language?

5. Do you have any concerns regarding your child's emotional health or behavior?

6.Would you have concerns that your child is hyperactive?

7. Does your child have any problems with hearing?

8. Does your child have any problems with his/her sight?

9. Does your child have a problem with day time wetting?

10. Do you have any other concerns about your child's health that you would like to discuss with the school administration or principal?