City of New Haven Burea of Nursing Health and Emergency Contact Information City of New Haven Burea of Nursing Health and Emergency Contact Information Welcome to the new school year! The New Haven Health Department provides school health and nursing services to students in New Haven Public Schools. The Nurse at your child’s school must have on file current health and emergency contact information to safely care for your child. * Select Your School Adult Education Augusta Lewis Troup Barack H. Obama Magnet University School Barnard Environmental Magnet Benjamin Jepson Magnet Betsy Ross Arts Magnet Bishop Woods Architecture & Design Brennan Rogers School of Communication and Media Celentano Clemente Leadership Academy Clinton Avenue School Columbus Family School Conte West Hills School Cooperative Arts And Humanities Davis Academy for Arts and Design Innovation East Rock School Edgewood School Elm City Montessori Engineering & Science University Magnet School Fair Haven School High School In The Community Hill Central Music Academy Hill Regional Career Magnet James Hillhouse High School John C Daniels School of International Communication John S Martinez Sea & Sky STEM Magnet School King Robinson Interdistrict Magnet School Lincoln-Bassett School LW Beecher School of Arts and Sciences Mauro Sheridan Science, Technology & Communications School "Metropolitan Business Academy " Nathan Hale School New Haven Academy Magnet Quinnipiac School Riverside Academy Ross Woodward Classical Sound School Truman School West Rock Authors Academy Magnet Wexler-Grant School Wilbur Cross High School Worthington Hooker School Student Information Name * First Last * Last Student Number (Lunch Number) * Instructions to access PowerSchool and student information. Click Here Date of Birth * Grade * Homeroom Parent/Guardian Information Name * First Last * Last Relationship * Please Select Mother Father After School Care Provider Agency Representative Aunt Before School Care Provider Brother Cousin Foster Father Foster Mother Friend GrandMother GrandFather Guardian Husband Neighbor Nephew Niece Self (Emancipated) Sister Sponsor StepBrother Step-Father Step-Mother StepSister Uncle Wife Other Cell Phone * Primary Work Phone * Primary Email * Place of Employement * Add Remove If the Parent/Gaurdian cannot be reached, call the following emergency contact Name First Last Last Relationship Please Select Mother Father After School Care Provider Agency Representative Aunt Before School Care Provider Brother Cousin Foster Father Foster Mother Friend GrandMother GrandFather Guardian Husband Neighbor Nephew Niece Self (Emancipated) Sister Sponsor StepBrother Step-Father Step-Mother StepSister Uncle Wife Other Phone Primary Add Remove Please answer the following questions. Have there been any changes in your child’s health history in the past year? * Yes No Does the child have any allergies (food, medications, environmental)? * Yes No Please list: Does the child have a diagnosed medical condition? * Yes No Please list: Will the child require medication or special nursing care during the school day? * Yes No Student’s Medical Provider: Phone Does the child have health insurance? * Yes No Please indicate type/name of insurer: Please note information provided on this form may be shared confidentially with Health Department nursing staff, administrators and appropriate educational personnel when necessary. Signature below allows permission to contact my child’s health care provider(s) as listed on this form for confidential release and exchange of health information to meet my child’s healthcare and educational needs. * Clear Date * Submit If you are human, leave this field blank.
