Dear Parents and Guardians,
The forms described below must be on file prior to starting the new school year. We are requesting that you complete these forms by Wednesday, August 5, 2020.
The Emergency Treatment Release Form provides the school with important medical information and gives the school and emergency personnel permission to administer first aid when needed. This form is required to be on file for each student and accompanies the student on all field trips.
The Authorization for Prescription Medication Form must be completed for any medication given at school on a daily basis. A separate form is required for students who need to carry an Inhaler, EpiPen, or Diabetic supplies. Please read the Medication Policy and fill out the necessary forms and return.
The Georgia Certificate of Immunization (GA form 3231) form may be obtained from your child’s physician or local health department. All seventh graders and new entrants* to Georgia schools must have a Tdap and Meningococcal vaccine, prior to the start of school. Students entering from out of state have 30 days to obtain a Georgia Immunization Certificate. An out of state certificate must be on file in the clinic. If your child has not been immunized for religious reasons, a notarized DPH Form 2208 must be provided. Medical exemptions must be on the GA form 3231 and must be reviewed annually with a new certificate issued. Returning students will have a certificate on file with the nurse and will not need a new one, unless the one on file is outdated or does not meet state requirements (such as 7th grade requirements). If you aren’t sure please contact me.
*New entrants include anyone that is entering Georgia schools for the first time or is returning to a Georgia school after being gone for more than 12 months or one school year.
If you have questions concerning this information, please contact me at 678-893-7775 or by email at firstname.lastname@example.org. Thank you for your cooperation.
Ann Hartin, RN
Mill Springs Academy School Nurse
2020-2021 Nurse Forms
- Emergency Treatment Form (fill out annually)
- Medication Policy
- Authorization for Prescription Medication
- Epipen, Inhaler and Insulin Authorization - this form is only necessary if your student will have an Epipen, Inhaler and/or Insulin on campus
- DPH Form 2208 - Affidavit of Religious Objection to Immunization
- Sports Physical Form - if participating in any sport, THIS form must be turned in annually.
Additional information you may find useful: