Current Students

Dear Parent or Guardian,

To comply with the school districts medication administration policy and Texas State Law, please review the
following information for medication administration.

1. All medication must be brought to school and kept in the nurse’s office in a locked storage unit.
2. Both prescription and non-prescription medications must be brought to the school in their original, properly labeled container. Prescription medication must contain a current pharmacy label.
3. A medication authorization form must be signed for all medications that are to be administered to the student.
4. School personnel will not give any medicine, including over the counter medications and products, to students except as authorized by district policy and with a signed medication authorization form.

This policy is necessary to protect the health and safety of your child. We appreciate your coopering in this matter for those reasons.

Sincerely,
Deb Jones, Nurse AISD

Please Fill Out The Medical & Emergency Contact Information Below

Emergency Contact

Parent/Guardian Email

Child's Name

Child's Date of Birth

Student's Gender

Reaquired field: Male

Reaquired field: Femal

Parent/Guardian Full Name

Phone Number

Street Address

City

State

ZipCode

Alternative Emergency Contact

First & Last Name

Relation to Student

Phone Number

Street Address

City

State

ZipCode

Secondary Emergency Contact

First & Last Name

Relation to Child

Phone Number

Street Address

City

State

ZipCode

Medical Information

Name of Hospital or Clinic Preference

Parent/Guardian Name

Parent/Guardian Phone Number

Insurance Company

Insurance Policy Number

Food Allergies

Medicine Allergies

Allergies or Special Considerations

Describe any medications, herbals, dietary supplements, or over the counter medications your child currently uses or intermittently takes.

Describe any serious reactions that can result from either administering or withholding madications.

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