Health Office Forms
New Students
Prior to enrollment, the school nurse must have immunization records and the following paperwork.
Physical and Dental Forms
Dental exams are required in Kindergarten, 3rd, & 7th grades.
Physical exams are required in Kindergarten, 6th, and 11th.
If you do not have a private physician or dentist, the school physician or dentist can complete the exam.
Dental exams are required in Kindergarten, 3rd, & 7th grades.
Physical exams are required in Kindergarten, 6th, and 11th.
If you do not have a private physician or dentist, the school physician or dentist can complete the exam.
Other Medical Forms
If your child needs to take medication during school hours, their provider will need to complete the Medication Consent form.
This includes: Inhalers, Epinephrine Auto Injectors, Insulin or Glucagon, or any prescribed oral medication.
***All medications need to be brought to school by a parent/guardian.***
***At the end of the school year, all medication needs to be picked up by a parent/guardian. See Medication Pick Up form.***
The only exception: Inhalers or Epinephrine Auto Injectors if the physician has given permission for the student to carry.
Tidioute Community Charter School carries a stock supply of Epinephrine Auto-Injectors. In the event that a student has an anaphylactic or life threatening allergic reaction to an unknown allergen in school, an Epinephrine Auto-Injector may be administered to the student. If you do not want an Epinephrine auto-injector to be administered to your child if they have an anaphylactic reaction, you must sign the form below and return it to the school nurse.
Tidioute Community Charter School carries Naloxone to be administered to overdose victims. Naloxone is a medication that can reverse an overdose that is caused by an opioid drug. When administered during an overdose, naloxone blocks the effects of opioids on the brain and restores breathing within two to eight minutes.
Naloxone has been used safely by medical professionals for more than 40 years and has only one function: to reverse the effects of opioids on the brain and respiratory system in order to prevent death.
Other Medical Forms
If your child needs to take medication during school hours, their provider will need to complete the Medication Consent form.
This includes: Inhalers, Epinephrine Auto Injectors, Insulin or Glucagon, or any prescribed oral medication.
***All medications need to be brought to school by a parent/guardian.***
***At the end of the school year, all medication needs to be picked up by a parent/guardian. See Medication Pick Up form.***
The only exception: Inhalers or Epinephrine Auto Injectors if the physician has given permission for the student to carry.
Tidioute Community Charter School carries a stock supply of Epinephrine Auto-Injectors. In the event that a student has an anaphylactic or life threatening allergic reaction to an unknown allergen in school, an Epinephrine Auto-Injector may be administered to the student. If you do not want an Epinephrine auto-injector to be administered to your child if they have an anaphylactic reaction, you must sign the form below and return it to the school nurse.
Tidioute Community Charter School carries Naloxone to be administered to overdose victims. Naloxone is a medication that can reverse an overdose that is caused by an opioid drug. When administered during an overdose, naloxone blocks the effects of opioids on the brain and restores breathing within two to eight minutes.
Naloxone has been used safely by medical professionals for more than 40 years and has only one function: to reverse the effects of opioids on the brain and respiratory system in order to prevent death.
