Nyack Public Schools Health Forms

Health Forms

Please note: all forms on this page are in .pdf format and require Acrobat Reader (download for free).

It is urgent that your child's emergency information be updated as necessary.
Our ability to contact you if your child becomes ill or if there is an emergency early dismissal at school depends on the accuracy of the information (phone numbers) we have. Please call 353-7013 to get a new form to update information.

Thank you.

New York State Education Law (pdf) - information about medical and dental records

Privacy Practices: Self-Funded Dental Program - notice of privacy (in compliance with the HIPPA law)

Dental Form (pdf) - to be completed by your child's dentist

Medication Form (pdf) - to be completed by your family's physician - required for dispensing medication.

Potassium Iodide Information - read the letter (pdf) sent home; read a question and answer sheet (pdf) about Potassium Iodide; and print and fill out the form (pdf) to have your child receive the treatment in case of emergency.

Nyack Public Schools