seamlessdocs@ufrsd.net
27 High Street, Allentown, NJ, 08501, US
609-259-7292
(This form can be completed online or printed and returned to the main office.)
Full Address
Does your child have a severe allergy (bee sting, food, medication, other)?
If Yes, what treatment is necessary?
If your child has any other health problem or physical limitation, please notify the school nurse.
Check consent for school nurse to administer medication during school day. (The school nurse is authorized to decline to administer a medication if the situation warrants.)
Medication Consent: I authorize the school nurse to administer the following medication.
The State of New Jersey requires that we ask the following questions:
Regarding Student Drivers: In the event your child become ill, this serves as written permission to permit your child to sign out of school and drive home provided they are physically able. Parent/Guardian will also be called for verbal permission to release student.
Full Name
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Full Date