Student Medical Form 24/25

Please enter a valid phone number.

A school physical and immunzation record is required to attend King's Academy. If you do not have a school physical or immunization record you may obtain one from The River Health & Wellness Center for a one-time fee. Pleasle visit TRHW.ORG for more information.

Please upload a completed Asthma Action Plan which you may download here. If you have any questions you can call the school nurse at (508) 379-7300 x106 or email nurse@kingsacademyne.com.

You will need to provide the King's Academy nursing staff with an un-expired Epi-Pen prior to the start of school.

Please upload a completed Epi-Pen Emergency Action Plan which you may download here. If you have any questions you can call the school nurse at (508) 379-7300 x106 or email nurse@kingsacademyne.com.

I consent on the date signed below that I have updated any necessary changes regarding my students medical information has been entered.*

In the event of an emergency either at school or at any school-related activities such as athletics, theater, field trips, overnight trips, etc., if the parents / guardians are unable to be reached, I First Name* Last Name* hereby authorize the school to arrange and/or administer emergency medical treatment for my child. The information I provided on this form is correct, and I understand that it is my responsibility to update the school nurse regarding any changes to my child’s health.

Signature Date

School Medical / Health / Immunization Form