Education Health & Safety Handbook

Education Health & Safety Handbook

Institution Information

Student Information

Student Name:

Date of Birth:    Student ID:

Parent / Guardian Information (if student is a minor)

Emergency Contacts

Medical Information & Consent

I authorize the institution to administer routine first aid and to seek emergency medical treatment if necessary. I authorize emergency treatment

I authorize designated school personnel to administer prescription medication to the student in accordance with written instructions from a licensed prescriber and pursuant to institution medication administration policies. I authorize medication administration

Immunization Status

The following statement reflects the student's immunization status and related declarations:

Student's immunizations are complete and up to date according to required schedules.

Student has a documented medical or legal exemption (an explanatory statement is required below).

Health & Safety Policies — Acknowledgment

By initialing and checking the items below, the signer affirms they have read, understand, and will comply with the institution's Health & Safety Handbook provisions. These provisions are binding while the student is enrolled and participating in institution programs.

I acknowledge receipt of, and will comply with, emergency response procedures (fire, lockdown, evacuation) and will follow staff instructions during drills or actual events.

I acknowledge policies for infection control and communicable disease mitigation; I will report illnesses and follow guidance for exclusion when necessary to protect the school community.

I acknowledge the medication administration policy, including requirements for written orders, labeled medication, and secure storage.

I acknowledge the food allergy and anaphylaxis management policy and understand my responsibilities to provide information and necessary medication (e.g., epinephrine).

I acknowledge rules governing off-campus activities, transportation, and supervision; I understand specific consent may be required for certain activities.

I acknowledge the incident reporting procedures and understand the institution's obligations to report serious injuries or suspected abuse to appropriate authorities.

I consent to the limited sharing of relevant health information with school personnel and emergency responders as necessary to provide care and ensure safety, consistent with applicable laws and institutional policy.

Additional Notices and Certifications

Mandatory Reporting: School staff are required by law to report suspected child abuse or neglect and may disclose information to appropriate authorities without prior parental consent if required by law or necessary to protect the student.

Data Handling: Medical and health records maintained by the institution are retained in secure files and accessed only by authorized personnel for the purpose of treatment, safety, and compliance with legal obligations.

I consent to the use of my child's image or likeness in institutional publications, promotions, or educational materials consistent with institutional policy.

Acknowledgment and Certification

The signer certifies that the information provided on this form is complete and accurate to the best of their knowledge. The signer further acknowledges receipt of the institution's Health & Safety Handbook, agrees to abide by its provisions while the student is enrolled, and understands the institution's authority to take reasonable actions to protect the health and safety of students and staff.

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