seamlessdocs@ufrsd.net
27 High Street, Allentown, NJ, 08501, US
609-259-7292
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:
Do you have medical insurance?
Will you accept a contact from an authorized medical insurance provider?
Full Name
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Full Date