SL]FFIELD ACADEMY - Suffield Academy

FORM rs DunnvJur.v L5,201.1
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Suffi eld, Connecticut 0 60 7 I
ACKNOWLEDGEMENT OF SUFFIELD ACADEMY MEDICAL PHILOSOPHY
Student name:
All Suffield students, both returning and new, must have an annual physical. A physical
completed after March 1 of this year is acceptable for the upcoming school year. The
completed form must be returned by the physician to the Health Center by July 15.If, for
insurance constraints, you are unable to have a physical completed and returned by July
15, please notify the Health Center with the date of the physical. Should this date fall
after the start of school, a note from the student's primary care provider must be
submitted to the Health Center stating that your daughter or son is cleared to participate
in all school and athletic activities until the time of the physical. No student will be
allowed to participate in the above without a physical or note.
Prescriptions that are self-administered must be accompanied by written directions as to
strength, dose, and duration by the student's physician. Prescriptions for controlled
substance drugs must be kept at the Health Center. All prescription medication kept on
campus must be checked in through the Health Center. Medications that are to be
kept in the dormitory will be noted in the medical record, and the Health Center will affix
a label to the bottle identifying that this is safe to keep in the dorm and is documented.
Medication not checked-in is considered contraband, and the matter will be transferred to
the Dean of Students' Office. A few medications (controlled and many psychotropics) are
required to be kept in the Health Center and dispensed by the Health Center staff. All
medications must be brought to the Health Center within 24 hours upon arrival or return
to school.
Any required immunizations that are not complete may be administered at the Health
Center.
Please sign below to acknowledge you understand Suffield's medical philosophy and that
you have completed all the medical forms to the best of your knowledge.
Parent signature
Date
Student Signature
Date
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