• RAINIER CHRISTIAN SCHOOL DISTRICT STUDENT HEALTH INFORMATION

    The following information is needed to plan and be prepared for any needs or emergency situation should one arise during school attendance.

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  • Emergency Contact: In sequence, in case of emergency:

  • Medical Information:

    A. HEALTH HISTORY: Please describe any significant or chronic medical problems such as asthmas, hay fever, diabetes, heart condition, seizure disorder, headaches, orthopedic, vision, surgeries, emotional problems, chronic colds or infections, speech difficulty, nose bleeds, etc.

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  • B. ALLERGIC TO: Medications (name):

  • MEDICAL AND/OR EMERGENCY RELEASE:

  • In the event of an emergency and all attempts to reach me/U.S. guardian have failed, and school authorities judge that immediate observation and/or treatment is necessary, I authorize and direct that my child receive such care as is necessary. Emergency treatment may require notification of an Emergency Aid Unit (911 Further treatment, based upon medical evaluation and recommendation, may be given. I understand that I assume responsibility for any payment of services rendered if required.

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  • PERMISSION TO ADMINISTER MEDICATION:

  • I understand that in the event my child needs to take over-the-counter or prescription medication, I must complete the Authorization for Administration of Oral Medication at School form.

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  • Authorization to Pick Up Student

    The following individuals are hereby authorized to pick up my child without further authorization and may also be contacted in the event of an emergency.

    Please include both the address and phone number for each individual. Your student will only be released to the people listed below. Please let your pick-up person know that they will be asked for ID before your child is released to them. This is for everyone's safety.

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