DDES - My Student-at-a-Glance 24

Downtown Denver Expeditionary School
My Student-at-a-Glance
Student’s Name*

First NameLast Name
Crew/Grade:*
Please list any known allergies:*
Does your student have medication they will need to take at school? *

YesNo
If yes, please list:
Does your student take medication at home that they will need for overnight camping trips? *

YesNo
Please list your student’s health care providers:
Primary Care Physician/Health Clinic:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone:*

Area CodePhone Number
Hospital of Choice:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dentist:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone:*

Area CodePhone Number
Mental Health Provider/Clinic:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone:

Area CodePhone Number
Does your student have an IEP? *

YesNo
Does your student have a Section 504 Plan?*

YesNo
Does your student have an up-to-date immunization record on file at DDES? *

YesNo
DPS policy requires that all students meet the legal requirements of the Colorado Immunization Law. In order for your child to attend school, immunization documentation needs to be on file at the school by the first day of attendance. If immunization documentation is NOT complete, the parent/guardian MUST see the school nurse before enrollment will be considered completed. You have the right to exempt your child from immunizations. During an outbreak, a student with an exemption may be subject to exclusion from school to quarantine.
Parent / Guardian Name*

First NameLast Name
Parent/Guardian Signature(s):*
Date*

MonthDayYear
Should be Empty:

Downtown Denver Expeditionary School

My Student-at-a-Glance