Student Shadow Form

In order to keep you child safe while they are in our care, please submit the following form once your shadow day has been confirmed.

Student's name * Required
First Last
Student's Date of Birth * Required
Month
Day
Year
Date your child hopes to shadow * Required
Mother's Name * Required
First Last
Mother's cell phone number * Required
Father's Name * Required
First Last
Father's call phone number * Required
Name of an emergency contact person (will only be contacted if parents connot be reached) * Required
First Last
Emergency cell phone number * Required
Relationship to student * Required
Student Medical Information
Does your child have a severe allergy that requires a prescription EpiPen * Required
If YES, your child should bring an EpiPen with them on shadow day and give to the school nurse.
- YES
- NO
Does your child have asthma and use an inhaler? * Required
If YES, your child should bring an inhaler with them on shadow day.
- YES
- NO
Medical Conditions * Required
Please list any other medical conditions (including allergies) that the school nurse should be aware of before treating your child. If there are none, please write "none".

If your child will require any medication during the school day, please contact our school nurse Lou Jones before their visit.
None
Medication Release * Required
- I understand that over-the-counter medications must be in their original container and labeled with my child's name.
  
  I understand that prescription medications must be in their original container including the pharmacy label with the child's name and dosage instructions.
Medical Release * Required
- If my child has medical conditions which may be relevant to a physician in the event of an emergency, I have listed them above. In the event an emergency occurs, I may be reached at the telephone number listed above. If I cannot be reached, I hereby authorize the TGS school nurse to make emergency medical decisions for my child.
Name of Person Submitting Form * Required
First Last
Email address to confirm receipt of this form * Required
Enter Email Confirm Email

Student Shadow Form

Student Medical Information

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