Student Medical – Aleph Bet Preschool

Registration Year

Student ID*

Student Name*

Birth Certificate

Please submit a copy of your child's birth certificate

Birth Certificate*

I will provide a copy before the first day of school
My child has a Birth Certificate on file
I will upload the Birth Certificate now

Upload Birth Certicate*

Health Form

A school entrance health form must be completed by your child’s physician and submitted to Aleph Bet by the first day of school. Click here to Download Health Form

Health Form*

The form will be mailed before the first day of school.
For returning students only: The health form I currently have on file will be updated and submitted after my child’s next well visit.
I will upload the completed Health Form now

Upload Health Form*

Allergies

Does your child have any allergies (food, medication, seasonal, other)?*

Yes
No

Allergies*

Allergy	Symptoms	What steps should be taken if a reaction occurs

Medical Consent

I authorize the staff at Aleph Bet Preschool, who are trained in First aid/CPR to administer first aid/CPR when appropriate. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child/ren. If I cannot be reached, I hereby authorize the staff at Aleph Bet to take any action they see necessary.*

I agree

Doctor/Hospital

Name of Doctor*

Doctor's Phone Number*

Preferred Hospital*