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Health Forms

Dear Parents/Guardians,

Welcome to Banyan School. My name is Lisa Bell, and I am the School Nurse.

So that I may best meet the needs of your child, it is important that the enclosed below Health Forms be filled out. Please return the completed forms to me prior to the new School Year.

Enclosed are the following:

Health & Emergency Card - Please fill out both cards on both sides. Include all numbers that can be used to reach you. In an emergency, we need to get in touch with you. PLEASE SIGN THE BACK OF THE CARDS.
Health History Form – Please complete and sign.
Physical Exam Form – This is to be filled out by your child’s Physician. A physical exam is recommended yearly. New students are required by the State of New Jersey to provide evidence of a recent physical exam to the school. This can come from your child’s previous school record.
Authorization to Administer Prescription Medication – Please have your child’s Physician complete this form if your child needs to receive prescription medication during school hours. A parent/guardian signature, as well as the Physician signature is needed on this form. All medications are to be sent to school in their original pharmacy container which is labeled with the child’s name, medication, and dosage.
Authorization for Non–Prescription Medication – This form is for all students. Please circle the medications you are giving me permission to administer to your child during school hours, if needed. These are the over-the counter medications I keep in stock. If there is something else you would like your child to have, please indicate this on the form, and provide the medication in its original container. An MD order with signature is required for OTC medications which are not listed on the form.
Authorization to Exchange Information – Please answer yes or no as to whether you will permit me to share or obtain pertinent information regarding your child. Please include all physicians you allow me to contact.

Immunization forms for new students must be in prior to the first day of the new school year. Your physician can fax this information if you authorize him/her to do so. The fax number at Banyan School is (973) 439-1396. Please direct all health information to the School Nurse.

If you have any questions, please call me at (973) 439-1919 ext. 106.

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