Campus Life
Health Services

Consent and Contacts

It is hard to believe that the school year is coming to a close and I am already planning for the upcoming year. Before we “check-out” on summer break we want to share some important information with you. We strive to provide our students with a safe and healthy environment while they are at Browne Academy, and we need your assistance as we all work together toward this common goal.
 
We are required by the State of Virginia to have certain information on file for every student by the first day of school, or they will NOT be allowed to attend. Please complete the form below along with any other applicable forms by Friday, June 1, 2018. Additionally, students new to the school for the 2018-2019 school year, along with students going into Kindergarten and 6th grade must complete the Commonwealth of Virginia School Entrance Form 
 
Additional health forms are also included, and are only required on a case-by-case basis. Please look at each form carefully to determine which apply to you and your child:
 
 I look forward to working together with you in the 2018-2019 school year. I hope you have a safe and healthy summer!
 
Kindest regards,
Ellen McGuire, RN
Director of Health Services
Student Information
(i.e. Marion Browne)
MM/DD/YYYY
Permission for Over-The-Counter Medications
The below information must be completed as it relates to over-the-counter medications. This section is only for the medications listed and will only be administered per manufacturer's recommended dosing provided to students Kindergarten through grade 8.
Emergency Contact Information
Please input two emergency contacts that are not the student's parents or guardians.
(i.e. Jane Doe)
(i.e. 571-451-1001)
Consent To Treat Statement
• I understand that in order to provide the safest possible environment and most complete education program for my child, the school needs to be informed of any health or medical conditions that may affect my child’s school day or impact their learning.
• I understand that medications of any kind are not allowed on school grounds without proper medical authorization on file. I understand that school staff, including any nurse, may not administer or assist with any medications without the proper medical authorization on file.
• I understand that for the safety of my child, or to provide for their educational program, the school nurse may need to share information about my child’s condition with appropriate school staff. This will be done in a confidential manner. If I do not wish that information shared, I must request this in writing and file it with the school nurse.
Browne Academy recognizes the desirability of following a Health Care Provider’s recommendation as closely as possible at school. The fact that this is a service or accommodation which the school is not legally required to perform is recognized by all parties signing this form and in so signing, they agree to hold Browne Academy, its officers and employees or agent, harmless from all liability suits and claims of whatever nature or kind which might arise, out of these arrangements.
Permissions
Health Policy (Please Read)
By signing below, I acknowledge that I have received and reviewed the school's Health Policy and Sick Child Guidelines. I also acknowledge that all information presented above is valid for my child and can be distributed, as necessary, to the appropriate members of the Browne Academy faculty and/or health care professionals for the benefit of my child.