SanGOSS Required Student Info

To be filled out by Parents.

San Gorgonio Outdoor
Science School

Student Registration & Health Information

Student Name(Required)
MM slash DD slash YYYY
Gender(Required)
Parent / Guardian Name

In case of Emergency, and you cannot be located, please list two other contacts:

STUDENT HEALTH INFORMATION AND AUTHORIZATION FOR TREATMENT

CHECK ALL CONDITIONS THAT APPLY TO YOUR CHILD

Hay Fever / Sinus:(Required)

For all children using inhalers, you MUST notify your child's teacher and school nurse.

MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY

Current Physical Conditions

Please check any of the following conditions that may apply.

Additional Information for a diabetic must accompany all other paper work.

Has your child been exposed to any communicable diseases within the past month?(Required)

Listed below are non-prescription medications that will be available if permission is given by the parent or guardian.

Anti-Itch lotion or tablet(Required)

Anti-Itch lotion or tablet(Required)
Anti / Acids(Required)
Lice Treatments(Required)
Decongestants(Required)
Throat Lozenges(Required)
Antihistamines(Required)
Eye Wash or Eye Drops(Required)
Ibuprofen, Acetaminophen(Required)
Sun Block(Required)
Hydrocortisone Cream (Itch / Rash / Burn Cream)(Required)
Dramamine(Required)
Petroleum Jelly(Required)

I hereby authorize the medical team to give the above non-prescription medications if deemed necessary.

Note: Insulin, Epi-kit, inhaler, prescription, and non-prescription medications must be sent to your school. Medications will be taken to the San G. Nurse who will dispense all medicines. All Medications (prescription and non-prescriptions) must be in their original containers. A medical authorization form signed by the parent and the prescribing physician must be sent with the medication.

SanGOSS Required Student Info

To be filled out by Parents.

San Gorgonio Outdoor
Science School

Student Registration & Health Information

Student Name(Required)
MM slash DD slash YYYY
Gender(Required)
Parent / Guardian Name

In case of Emergency, and you cannot be located, please list two other contacts:

STUDENT HEALTH INFORMATION AND AUTHORIZATION FOR TREATMENT

CHECK ALL CONDITIONS THAT APPLY TO YOUR CHILD

Hay Fever / Sinus:(Required)

For all children using inhalers, you MUST notify your child's teacher and school nurse.

MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY

Current Physical Conditions

Please check any of the following conditions that may apply.

Additional Information for a diabetic must accompany all other paper work.

Has your child been exposed to any communicable diseases within the past month?(Required)

Listed below are non-prescription medications that will be available if permission is given by the parent or guardian.

Anti-Itch lotion or tablet(Required)

Anti-Itch lotion or tablet(Required)
Anti / Acids(Required)
Lice Treatments(Required)
Decongestants(Required)
Throat Lozenges(Required)
Antihistamines(Required)
Eye Wash or Eye Drops(Required)
Ibuprofen, Acetaminophen(Required)
Sun Block(Required)
Hydrocortisone Cream (Itch / Rash / Burn Cream)(Required)
Dramamine(Required)
Petroleum Jelly(Required)

I hereby authorize the medical team to give the above non-prescription medications if deemed necessary.

Note: Insulin, Epi-kit, inhaler, prescription, and non-prescription medications must be sent to your school. Medications will be taken to the San G. Nurse who will dispense all medicines. All Medications (prescription and non-prescriptions) must be in their original containers. A medical authorization form signed by the parent and the prescribing physician must be sent with the medication.