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Student Health Information Form

Please complete the form below. Required fields marked *
Does your child have any medical/health conditions?*
Does your child need to take medications at school?*
Does your child have medical 504 Plan and/or IEP Plan (past or present)?*
Does your child have any food allergies?*
Does your child currently have health insurance?*

If not and you would like assistance enrolling your child in a free/low-cost health insurance program, please complete the following information so that someone may contact you. 

Statement of Confidentiality: The information gathered from this document is confidential and will be used for the sole purpose of obtaining resources and providing assistance to A.C.E. Academy students and their families. Information obtained will only be utilized by A.C.E. Academy staff/employees and wil not be shared with an additional entity. 

Confirmation Email