CARE PLAN FOR CHILDREN WITH SPECIAL HEALTH NEEDS -To be completed by a Health Care Provider-

Regulation 757-3 STUDENTS November 13, 2013 STUDENTS. Student Health Services and Requirements

STUDENTS November 13, 2013 STUDENTS Student Health Services and Requirements Guidelines for School Staff/Child Care Contractor (CCC) to Carry Out Health Treatment Procedure and/or Emergency Treatment Procedures

Individualized Healthcare Plan (IHP) Core Form

Individualized Healthcare Plan (IHP) Core Form An Individualized Healthcare Plan (IHP) should be developed by the parents/guardian, school nurse, student and other pertinent school officials. This plan

ADMINISTRATIVE PROCEDURE. Request for School Assistance in Health Care (Administration of Prescribed Medication)

ADMINISTRATIVE PROCEDURE SO102 Request for School Assistance in Health Care (Administration of Prescribed Medication) Board Received: Review Date: February 2014 Accountability: 1. Frequency of Reports

DEFINITIONS: For purposes of this policy, the definitions included in this section apply:

STUDENTS Administrative Procedures 516A Administering Prescribed Medication in School Students may require prescribed medication at school in order to benefit from their educational experience. The following

If your child fails the screening, you will be informed of test results. Please direct any questions to the. school nurse at.

If your child passes the vision screening, you may not be contacted by the school nurse. A vision screening provides only a snapshot of how your child performs on the day the test was administered and

Early Care & Education Family Toddler Lab Infant/Toddler Needs and Service Plan. Semester/Year: Summer/ Fall/ Spring/

Early Care & Education Family Toddler Lab Infant/Toddler Needs and Service Plan Semester/Year: Summer/ Fall/ Spring/ CHILD S INFORMATION Child s Name: of Birth: Parent s Name: Reviewed: Feeding Plan: Liquids

Please put above in a plastic Ziploc bag with your child s name on it.

Dear Parent(s), You have noted your child has medications related to an allergic reaction. The Stamford Museum & Nature Center s requirements for noted medications are as follows: Epi-pen requirements

Plum Borough School District Nursing Services Department

Information Regarding the Student with an Allergy Student s Name Grade Homeroom Date Physician s Name Physician s Phone # Type of Allergy (Food, Bee, Wasp, Latex, Other: Specify): Type of Reaction: For

Dymond Speech & Rehab., P.A. Patient Registration Information

Dymond Speech & Rehab., P.A. Patient Registration Information Client s Name: First Middle Last Street Address: Mailing Address: City : State: Zip code: Sex: Home Phone: ( ) - Cell: ( ) - Other: ( ) - of

SPRINGFIELD TOWNSHIP SCHOOL DISTRICT

No. 209.1 SPRINGFIELD TOWNSHIP SCHOOL DISTRICT SECTION: TITLE: PUPILS FOOD ALLERGY MANAGEMENT ADOPTED: November 19, 2013 REVISED: 209.1. FOOD ALLERGY MANAGEMENT 1. Purpose The Board is committed to providing

Medication Administration Guidelines for Child Care Programs

Medication Administration Guidelines for Child Care Programs A. Medication Administration Policy The child care program will administer medication to children for whom a plan has been made and approved

ROLE OF THE PARENT/LEGAL GUARDIAN IN THE ADMINISTRATION OF MEDICATION AT SCHOOL

ROLE OF THE PARENT/LEGAL GUARDIAN IN THE ADMINISTRATION OF MEDICATION AT SCHOOL The parent/legal guardian who wishes medication to be administered at school to his/her child has the following responsibilities:

Schools must maintain up-to-date information on any student who has a medical condition that may require emergency care at school.

POLICY NO. 5140 MEDICAL ALERT AND ADMINISTERING MEDICATION TO STUDENTS POLICY Schools must maintain up-to-date information on any student who has a medical condition that may require emergency care at

2008 Greenville Speech & Language Therapy, PLLC

Greenville Speech & Language Therapy, PLLC ADULT PATIENT REGISTRATION FORM 18 YEARS AND OLDER PATIENT INFORMATION PATIENT S NAME: DATE OF BIRTH: _- _- SEX: MALE FEMALE SS#:_ - - ADDRESS: _ CITY: STATE:

Z Take this folder with you to your

my health care notebook Why? Being an active part of your health care team helps you feel better and helps you get even better care. Starting on Day 1, you can keep track of important information and questions.

Liberty Union High School District Administrative Regulation

Page 1 of 7 Definitions Authorized health care provider means an individual who is licensed by the State of California to prescribe or order medication, including, but not limited to, a physician or physician

Crosspoint Clubhouse

Crosspoint Clubhouse To the Parents/Guardians of The health and safety of our students is a priority for our school. Because your child has a life threatening allergy that may require the use of an Epinephrine

Winter Camp 2015 Church Registration Instructions and Policies

Winter Camp 2015 Church Registration Instructions and Policies Registration Instructions: 1) Choose your weekend(s). Prayerfully consider which available weekend is the best for your church. Bring your

Health Conditions in Schools Alliance www.medicalconditionsatschool.org.uk Individual Healthcare Plan

Health Conditions in Schools Alliance www.medicalconditionsatschool.org.uk Individual Healthcare Plan 1 CHILD/ YOUNG PERSON S INFORMATION 1.1 CHILD/ YOUNG PERSON DETAILS Child s name: Date of birth: Year

Chicago Public Schools Policy Manual

Chicago Public Schools Policy Manual Title: ADMINISTRATION OF MEDICATION POLICY Section: 704.2 Board Report: 12-0125-PO2 Date Adopted: January 25, 2012 THE CHIEF EXECUTIVE OFFICER RECOMMENDS: That the

Preschool Learning Center

Preschool Learning Center GUIDELINES AND INFORMATION ON FEEDING AND SAFE MEALTIME PRACTICES FOR STUDENTS IN A SCHOOL SETTING I. RATIONALE FOR FEEDING GUIDELINES The number of children with severe disabilities

JHCF-R2. Food Allergy Guidelines September 4, 2014. Alexandria City Public Schools School Health Guidelines Managing Food Allergies in Schools

Food Allergy Guidelines September 4, 2014 Alexandria City Public Schools School Health Guidelines Managing Food Allergies in Schools 1 Alexandria City Public Schools School Health Guidelines Managing Food

Al Wooten Jr. Heritage Center. Summer Fun Camp REGISTRATION FORM. Student 1: When will Student 1 attend? Mon-Fri, 8am-6pm / Other schedule

REGISTRATION FORM Student 1: When will Student 1 attend? Mon-Fri, 8am-6pm / Other schedule Student 2: When will Student 2 attend? Mon-Fri, 8am-6pm / Other schedule Scholarship requested for low-income

Yes, per qualifications outlined in the SEMI Provider Handbook, Practitioners must

FAQ s #1. Are clinical fellowship year (CFY) practitioners (service providers who are in the process of earning their Certificate of Clinical Competence (CCC) required to work under the direction? Yes,

Ferry Beach Ecology School Medical Management Plan -- Student with Chronic Illness or Severe Allergy

Medical Management Plan -- Student with Chronic Illness or Severe Allergy Students at Ferry Beach Ecology School (FBES) have full access to health services by a school nurse. The FBES nurse will identify

Appendix A: Questions and Answers

Appendix A: Questions and Answers Roles and responsibilities for nursing procedures and health-related activities in school and during all school-sponsored activities is complex and, at times, difficult

Point Isabel ISD Child Nutrition Department

Point Isabel ISD Child Nutrition Department 101 Port Road Port Isabel, TX 78578 Phone: 956-943-0079 Fax: 956-943-0095 Accommodating Children with Special Dietary Needs Req uired Documentation Each special

ADMINISTRATION OF MEDICATIONS POLICY

Policy 6.007. ADMINISTRATION OF MEDICATIONS POLICY It is the policy of Cooperative Educational Services (C.E.S.) that students who require any medications to be administered during school hours, including

OFFICE OF CATHOLIC SCHOOLS ARCHDIOCESE OF CHICAGO

OFFICE OF CATHOLIC SCHOOLS ARCHDIOCESE OF CHICAGO SCHOOL MEDICATION PROCEDURES Parents/guardians have the primary respomibility for (he adminislration of medical ion to their children. The administration

Physical, Occupational, Speech & Developmental Therapy

Physical, Occupational, Speech & Developmental Therapy Let me begin by saying thank you for choosing Allied Therapy and Consulting Services as your child s therapy provider. We hope to make this a smooth

FMLA: Certification of Health Care Provider for Employee s Serious Health Condition

FMLA: Certification of Health Care Provider for Employee s Serious Health Condition Route this form to: Supervisor/responsible administrator U Wide Form: UM 1515 Rev: Mar 2009 NOTE: Failure to fully complete

GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR

GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR Welcome Child s Enrollment Form Parent Pick-Up Authorization Emergency Information, Waiver & Medical

IHPs, 504 Plans, and IEPs: What s the Difference?

IHPs, 504 Plans, and IEPs: What s the Difference? Donna Noble Our thanks to Donna Noble for compiling the information below about the different tools available to help homepen children overcome some of

5-K: SPECIAL EDUCATION EARLY CHILDHOOD PROGRAMS AND SERVICES

5-K: SPECIAL EDUCATION EARLY CHILDHOOD PROGRAMS AND SERVICES The only pupils under the age of five who may be counted in membership are pupils with an individualized educational program (IEP) or an individualized

Students. Burr Ridge Community Consolidated School District #180 Policy Manual 7:270. Administering Medicines to Students 1

Burr Ridge Community Consolidated School District #180 Policy Manual 7:270 Administering Medicines to Students 1 Students Students should not take medication during school hours or during school-related

SAMPLE SECTION 504 PLAN

SAMPLE SECTION 504 PLAN The attached sample Section 504 Plan was developed by the American Diabetes Association (ADA) and the Disability Rights Education and Defense Fund, Inc. (DREDF). 0 MODEL 504 PLAN

Youth Camp Civic Center

Youth Camp Civic Center Household ID # Please circle the session(s) that your child(ren) will attend Session One June 8- June 12 Session Two June 15 June 19 Session Three June 22 June 26 Session Four June

Frequently Asked Questions

Frequently Asked Questions 1. What are billable services? Billable services are identified in the Medicaid Certified School Match Handbook. Each chapter discusses what is permissible for billing according

Students 4000 OP 4.600. Medical Alert

Students 4000 OP 4.600 Medical Alert BACKGROUND There are students in school who may require emergency care interventions by school staff. These students are commonly referred to as students with a medical

MEDICATION ADMINISTRATION PROCEDURE

MEDICATION ADMINISTRATION PROCEDURE Objective: To provide procedure and protocols to ensure the safe administration of medication to students at school. Always refer to FFAC Legal and FFAC Local for district-approved

Physical Therapists and Occupational Therapists. An Overview

Physical Therapists and Occupational Therapists An Overview Federal regulations permit and encourage school systems to recover costs from public health insurance (Medicaid) for services identified in a

If#Your#Child#Requires#Medication#While#at#Camp:#

If#Your#Child#Requires#Medication#While#at#Camp:# All prescription and nonprescription medication given in child care, camp or school settingsrequireawritten#authorizationfromyourhealthcareprovider,aswellasparent

The Public Schools of Verona, New Jersey

The Public Schools of Verona, New Jersey Procedure for Epi-Pen administration in the Verona Schools 1. The school nurse will provide the parent with the paperwork that must in place for epinephrine administration.

Medicaid Certified School Match Program Frequently Asked Questions

Medicaid Certified School Match Program Frequently Asked Questions 1. Medicaid defines small group therapy sessions to include at least two students. I understand that if the group session has three to

TECHNICAL ASSISTANCE REFERRAL PACKET

TECHNICAL ASSISTANCE REFERRAL PACKET The Minnesota DeafBlind Project provides FREE technical assistance to families, education teams and service providers to support children (from birth through the year

Vermont Medicaid Training 2013-2014. Copyright MSB 2013 Revision Date 9/4/13

Vermont Medicaid Training 2013-2014 Copyright MSB 2013 Revision Date 9/4/13 SCHOOL-BASED Health Services Program The Medicaid School-Based Health Services Program is used by the State to generate Medicaid

EXCEL PHYSICAL THERAPY, INC.

EXCEL PHYSICAL THERAPY, INC. Medical History Form Name: Date of Birth: Date: Are you employed? YES NO Right Handed Left Handed If NO, last day worked? Do you smoke? YES NO #of packs/day Occupation: Height:

American Academy of Pediatrics Section on Breastfeeding. Ten Steps to Support Parents Choice to Breastfeed Their Baby

American Academy of Pediatrics Section on Breastfeeding 1 2 3 4 5 6 7 8 9 10 Ten Steps to Support Parents Choice to Breastfeed Their Baby This practice enthusiastically supports parents plans to breastfeed

Date of birth: Starting Date Deposit Paid: Relationship to child: Home Tel. Work Tel. Mobile. Relationship to child: Home Tel. Work Tel.

ENROLMENT FORM Places are only held once a form has been returned and 150 deposit has being paid. Name of child: Date of birth: Starting Date Deposit Paid: Parent / Guardian name: Home Relationship to

Certification of Health Care Provider for Family Member s Serious Health Condition (Family and Medical Leave Act)

Certification of Health Care Provider for Family Member s Serious Health Condition (Family and Medical Leave Act) Section I: For Completion by the Administrator INSTRUCTIONS to the Administrator: The Family

Please email: tchin@sbnature2.org for more details.

Medication Protocol: All medications (both over-the-counter and prescribed) must be cleared by the camper s guardian (additionally all prescribed meds must be cleared by a Physician) by filling out the

PEDIATRIC - CASE HISTORY FORM

Thank you, for choosing Access Rehab Centers. We kindly request that you fill out all the necessary information for our therapists to complete a comprehensive evaluation of your child. Please mail this

Section 504 Plan (pg 1 of 8)

Section 504 Plan (pg 1 of 8) of Birth School Today s Section 504 Plan for: Disability: Diabetes School Year: Grade: Homeroom Teacher: Bus Number: Background Objectives The student has type diabetes. Diabetes

Taking Chiari to School: A Guide for Parents. Prepared by Suzanne Oró, RN, MSN-ed

lorem I HAVE Ch i a r i (kee-ar-ee) Taking Chiari to School: A Guide for Parents Prepared by Suzanne Oró, RN, MSN-ed This guide is dedicated to the parents of children with Chiari who tirelessly advocate

SCHOOL DISTRICT OF SHOREWOOD. Managing Serious Adverse Allergic Conditions

SCHOOL DISTRICT OF SHOREWOOD 453.61 Managing Serious Adverse Allergic Conditions The Shorewood School District recognizes that allergic reactions may be a serious life threatening medical condition. The

for Young Children with Special Needs

for Young Children with Special Needs to Baltimore City Public Schools! As a parent or guardian, you have an essential role to play as your child s first teacher. And, as a parent or guardian of a young

ROCHESTER AREA SCHOOL DISTRICT

No. 210 SECTION: PUPILS ROCHESTER AREA SCHOOL DISTRICT TITLE: USE OF MEDICATIONS ADOPTED: August 11, 2008 REVISED: August 25, 2014 210. USE OF MEDICATIONS 1. Purpose The Board shall not be responsible

TONGUE/LIP TIE PATIENT INFORMATION

TONGUE/LIP TIE PATIENT INFORMATION Today s Date: Patient s DOB: Patient s Name: Parent s Name(s): Main Concerns: Pediatrician s Name: Are you currently working with a lactation consultant? If so, who?

INSTRUCTIONS TO LICENSED HEALTH CARE PROVIDERS: AFTER

RESIDENT HEALTH ASSESSMENT for ASSISTED LIVING FACILITIES This form must be completed annually for residents receiving assistive care services in order to comply with Medicaid TO BE COMPLETED BY FACILITY:

ADMINISTRATION OF PRESCRIPTION MEDICATIONS IN SCHOOLS OBJECTIVES. Purpose of Regulations 105 CMR 210.000. Diane M. Gorak, RN, MEd

ADMINISTRATION OF PRESCRIPTION MEDICATIONS IN MASSACHUSETTS SCHOOLS Diane M. Gorak, RN, MEd OBJECTIVES Review Massachusetts Regulations Recognize Challenges Ensure Safe Delivery of Prescription Medications

BIIAB Level 3 Diploma in Children s Learning and Development (Early Years Educator) (QCF)

Optional Units BIIAB Level 3 Diploma in Children s Learning and Development (Early Years Educator) (QCF) 601/7786/X Version 1 BIIAB November 2015 Contents Optional Group B Unit No. 3CLD10 3CLD11 3CLD12

Elk Grove Park District Preschool Date

Class For Office Use Only New/Readmit Birth Cert. In/Out of Dist Release Medical Elk Grove Park District Preschool Date Name of Child M F Date of Birth Age Primary Phone # Address City Zip Primary e-mail:

Guidelines for Developing a Protocol/Procedure for the Administration of Medication

Appendix 1 Guidelines for Developing a Protocol/Procedure for the Administration of Medication The Child Care (Pre-School Services) (N0 2) Regulations 2006 and Explanatory Guide to Requirements and Procedures

Eastgate Early Childhood & Family Center

Eastgate Early Childhood & Family Center A seven member Board governs the Stark County Board of Developmental Disabilities: Robert Milliken, President Richard Hoffman, Vice President Carlene Harmon, Secretary

FERNDALE AREA SCHOOL DISTRICT

No. 210 SECTION: PUPILS FERNDALE AREA SCHOOL DISTRICT TITLE: MEDICATIONS ADOPTED: AUGUST 1985 REVISED: DECEMBER 6, 2000 MAY 9, 2007 JUNE 17, 2009 JUNE 18, 2014 210. MEDICATIONS REVISED: 1. Purpose The

REHAB XCEL, LLC. NEW PATIENT INFORMATION

REHAB XCEL, LLC. NEW PATIENT INFORMATION DATE: NAME: LAST: FIRST: MID: MAIL ADDRESS: HOME PHONE: CELL PHONE: WORK PHONE: DATE OF BIRTH: SS# SEX: M OR F EMERGENCY CONTACT: PHONE: MARITAL STATUS: M OR S

Name Date. Doctor. Usual times to test glucose at school Extra tests (check those that apply) before exercise after exercise other (explain)

Appendix A SAMPLE IHP Name Date Phone numbers Blood glucose Hypoglycemia Hyperglycemia Insulin Parent/guardian#1 Work Home Parent/guardian#2 Work Home Other emergency contact Doctor Usual times to test

Practice Management & Electronic Health Record Systems: School-Based Health Center Requirements & Configuration Considerations.

Practice Management & Electronic Health Record Systems: School-Based Health Center Requirements & Configuration Considerations May 23, 2012 Introduction In today s rapidly changing health care environment,

Wyckoff Administration Policy on Epinephrine Nurse, Student and or Delegate

Wyckoff Administration Policy on Epinephrine Nurse, Student and or Delegate It is the policy of this school to apply New Jersey Law N.J.S.A. 18A: 40-12.3-12.6 in the following way: The school will provide

Student Health Service FAQs for the Parent and Family Liaison

1 Student Health Service FAQs for the Parent and Family Liaison Do I need to send my son or daughter with our prescription insurance card to the University Pharmacy (located at the Student Health Service)

Documenting Therapy Services under IDEA 2004

CHAPTER 5 Documenting Therapy Services under IDEA 2004 Documenting Therapy Services on an IFSP As with IEPs, therapy services on the IFSP may be listed as supplemental aids and services, adaptations, accommodations

Health Professions Act BYLAWS SCHEDULE F. PART 3 Residential Care Facilities and Homes Standards of Practice. Table of Contents

Health Professions Act BYLAWS SCHEDULE F PART 3 Residential Care Facilities and Homes Standards of Practice Table of Contents 1. Application 2. Definitions 3. Supervision of Pharmacy Services in a Facility

Rutland Community School Tel: 250-765-4052 REGISTRATION FORM

Rutland Community School Tel: 250-765-4052 620 Webster Road Kelowna, BC V1X 4V5 Fax: 250-870-5066 REGISTRATION FORM General Information Child Name Middle Name Nick Name Weight Height Sex (circle) M F of

Address: Street City State Zip Code Home Phone: E-mail Address:

SANDWICH CUSD #430 REGISTRATION FORM SCHOOL YEAR 2013-2014 SELECT AN ATTENDANCE CENTER LG Haskin Prairie View WW Woodbury HE Dummer Middle School High School 1. NAME: 5. SEX: Male Female Last Name First

Policies for Easter Seals South Carolina Therapy Services

Policies for Easter Seals South Carolina Therapy Services It is our goal to serve you and your child with excellence. Please carefully read through the following policies. 1. During or prior to your initial

Montessori Children s House Registration Form. Child s Name: Start date: Place of Employment. Place of Employment

Montessori Children s House Registration Form Child s Name: Start date: Date of Birth: Nickname: Mother s Name: Mother s Address: Contact Numbers Place of Employment Work Address Work Phone Social Security

TYPE 2 DIABETES PROCEDURES AND FORMS ELEMENTARY SECONDARY SCHOOL ADMINISTRATOR

TYPE 2 DIABETES PROCEDURES AND FORMS ELEMENTARY SECONDARY SCHOOL ADMINISTRATOR 2013 SCHOOL ADMINISTRATOR TYPE 2 DIABETES PROCEDURES and FORMS: Parent/guardian informs school administrator child/youth has

Medication Administration and Delegation in Massachusetts Schools Training Manual

Medication Administration and Delegation in Massachusetts Schools Training Manual Massachusetts Department of Public Health School Health Unit GUIDELINES FOR REVIEWING AND APPROVING APPLICATIONS TO REGISTER

OKLAHOMA SCHOOL FOR THE DEAF DEAF AND HARD OF HEARING SUMMER CAMP HIGH SCHOOL JUNE 14-19, 2015 ELEMENTARY SCHOOL JUNE 21-24, 2015 REGISTRATION DAY

OKLAHOMA SCHOOL FOR THE DEAF DEAF AND HARD OF HEARING SUMMER CAMP HIGH SCHOOL JUNE 14-19, 2015 ELEMENTARY SCHOOL JUNE 21-24, 2015 REGISTRATION DAY WHEN: JUNE 14 th (High School) JUNE 21 nd (Elementary)

Psychiatric Consultants of Atlanta, P.C. 1835 Savoy Drive Suite 101 Atlanta, Georgia 30341 Phone: 770-234-0981 Fax: 770-234-0252 www.pcatl.

Psychiatric Consultants of Atlanta, P.C. 1835 Savoy Drive Suite 101 Atlanta, Georgia 30341 Phone: 770-234-0981 Fax: 770-234-0252 www.pcatl.com CONTACT INFORMATION AND PERSONAL DATA Name: Date of Birth:

INDIVIDUAL FAMILY SERVICE PLAN (IFSP)

INDIVIDUAL FAMILY SERVICE PLAN (IFSP) Check here if this is an Interim IFSP Resident District: IFSP Meeting Date: IDENTIFYING INFORMATION MARSS ID #: Gender: M F Date of Birth: / / School: Providing District

Important Information Please keep this page for your records

Camp Horizon Important Information Please keep this page for your records 1. Complete the enclosed application and the scholarship form thoroughly. Mail them immediately to the camp address listed below.

SPECIAL EDUCATION STAFF AR 4112.23

Qualifications/Assignment of Special Education Teachers Any teacher assigned to serve students with disabilities shall possess an appropriate credential or other authorization that specifically authorizes

HEAD START PERFORMANCE STANDARDS W/ MENTAL HEALTH FOCUS

HEAD START PERFORMANCE STANDARDS W/ MENTAL HEALTH FOCUS This list represents a variety of Head Start Performance Standards that include some aspect of mental health; however, it is not exhaustive of every

LOCAL OFFER As part of the Children and Families Bill (2014), schools are required to publish and keep under review, information about services they expect to be available in their setting for children

Outpatient Prescription Drug Benefit

Outpatient Prescription Drug Benefit GENERAL INFORMATION This supplemental Evidence of Coverage and Disclosure Form is provided in addition to your Member Handbook and Health Plan Benefits and Coverage

St Bernard s Catholic School. Administration of Medicine Policy

St Bernard s Catholic School Page 1 of 10 The St Bernard s administration of medicine policy has been developed to ensure that children with medical needs have the same access to education as their peers

Nurse Practitioners (NPs) and Physician Assistants (PAs): What s the Difference?

Nurse Practitioners (NPs) and Physician Assistants (PAs): What s the Difference? More than ever before, patients receive medical care from a variety of practitioners, including physicians, physician assistants

Medical Information Checklist For Indian Youth Summer Camp

Medical Information Name (First): Name (Last): Birth date: Age: Sex: Parent or guardian: Home Relationship to camper: Second Parent or guardian (or spouse): Home Relationship to camper: Emergency Contact

Daily Homework Help Time Outdoor Games Warm & Caring Environment Friendly & Qualified Staff Theme-Based Curriculum Arts & Crafts

GENERAL INFORMATION AFTER SCHOOL 2015-16 After School Programs are provided for youth who attend school in the Town of Amherst. The program operates Monday Friday from 2:00-5:30pm. An Extended Afternoon

DIABETES PACKET. To ensure your child s well-being, please provide the school with the following supplies:

NSG-203A NORTH ROYALTON CITY SCHOOLS 6579 Royalton Road North Royalton, Ohio 44133 DIABETES PACKET Dear Parent/Guardian: You have indicated that your child has Diabetes. Please complete the attached SCHOOL

Educational Physical Therapy Guidelines and Policies For Educationally Based PT in Glenn County Schools

Educational Physical Therapy Guidelines and Policies For Educationally Based PT in Glenn County Schools Glenn County SELPA Glenn County Office of Education 311 S. Villa Willows, CA 9588 (530) 934-6575

Preventive Health Care for Children in a Medical Home

INSTRUCTOR S GUIDE Preventive Health Care for Children in a Medical Home First Edition, 2006 California Childcare Health Program Administered by the University of California, San Francisco School of Nursing,

POLICY 4060 MEDICAID REIMBURSEMENT FOR HEALTH-RELATED SERVICES. I. Policy Statement

BOARD OF EDUCATION POLICY 4060 MEDICAID REIMBURSEMENT FOR HEALTH-RELATED SERVICES Effective: July 1, 2009 I. Policy Statement The Board of Education recognizes its responsibilities to provide services

ADMINISTRATION OF MEDICATION TO STUDENTS POLICY

CODE: C.009 Program CONTENTS ADMINISTRATION OF MEDICATION TO STUDENTS 1.0 PRINCIPLES 2.0 POLICY FRAMEWORK 3.0 AUTHORIZATION POLICY 1.0 PRINCIPLES 1.1 The primary responsibility for administering medication

CSBA Sample Administrative Regulation Special Education Staff

CSBA Sample Administrative Regulation Special Education Staff AR 4112.23 Personnel Qualifications/Assignment of Special Education Teachers Any teacher assigned to serve students with disabilities shall

Kansas Infant Toddler Services. Individual Family Service Plan (IFSP) Guidance Document

Kansas Infant Toddler Services Individual Family Service Plan (IFSP) Guidance Document 1 TABLE OF CONTENTS INTRODUCTION...3 IFSP COVER PAGE...6 CHILD AND FAMILY INFORMATION 7 IMPORTANT DATES.10 ELIGIBILITY

Dear Parents: We appreciate the opportunity to work with your child and look forward to getting to know your family. Sincerely,

Dear Parents: Thank you for considering Mobile Therapy Centers of America, LLC (MTC) for your child s therapy needs. At MTC, we strive to provide the highest quality of therapeutic intervention. Our services

Louisiana School for the Visually Impaired Orientation and Mobility Summer Camp Programs May 31 June 4 and June 7 11, 2015

Louisiana School for the Visually Impaired Orientation and Mobility Summer Camp Programs May 31 June 4 and June 7 11, 2015 To: Interested Parents and Students Re: Camp Registration Forms Thank you for

The Nursing Department of Central CUSD 301 provides nursing services that promote students ability to learn. Our goals are to:

Date Dear (Parent / Guardian), The Nursing Department of Central CUSD 301 provides nursing services that promote students ability to learn. Our goals are to: o Assist students in learning how to take care