MEDICAL INFORMATION FORM

 

Student Information

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Permission to Receive Medication

By signing this form I understand that Charlotte County Christian Academy is not responsible for any injury or harm that may occur as a result of this medication.  Charlotte County Christian Academy reserves the right to revoke this privilege if it is being abused (constant use of pain medication, etc.).*In order to receive pain medication, students must check with their Home Room teacher before coming to the school office for such medication.*

My child will be permitted to be given the following pain medication(s) during school hours if necessary, understanding that this does not mean they are allowed to abuse this privilege. (Please check all allowable ones)

IMMUNIZATION RECORD is required for all elementary students enrolling in our school.

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Emergency Information and Medical Treatment

I hereby authorize Charlotte County Christian Academy to call an emergency ambulance in case of accident or acute illness, and to arrange for necessary emergency medical aid and surgical care in the case that I, or the designated guardian, am not immediately available.  Any qualified physician, called by CCCA, may treat and do whatever is necessary for the health and well-being of my child. It is understood that a conscientious effort must be made to notify me before such action will be taken.  I also agree to accept responsibility for the cost of the above medical services.