Nurse’s Forms

Please find all of the required forms for your child’s enrollment below. If you have any questions, please feel free to email the school nurse, Regina Bryant.

1. The Centreville Layton School Emergency and Medical Information Card must be filled out each year for the coming school year. This form is required if your child needs to be seen by the nurse, or in the event your child needs to be transported to the hospital.
2. All Students in the Lower School are required to fill out a Delaware Student Health Form – Children PreK – Grade 6 every 2 years.
3. Your child’s Immunization Record must be attached. This record must be current as required by Delaware state law. Please review your child’s record with your pediatrician to make sure all immunizations are up-to-date.
4. All Students in 7-12th grades must submit a DIAA Physical each year, regardless of athletic team intentions. Your child’s current immunization record must be attached to this physical.
5. If your child will be taking any prescription medication during the school day, or over-the-counter medication that is not kept in stock, you must complete the enclosed Parental Request to Have Medication Administered in School Form. Please bring in the medication and completed form and leave them with Diane Daiger at the front office or give directly to Regina Bryant, school nurse.
6. If your child has a severe allergy and uses an epi-pen, you must provide the school with the epi-pen(s) and the Prevention and Emergency Response Plan for Students with Allergies filled out by your child’s physician. The school Nurse’s Office stocks diphenhydramine (Benadryl) for these emergencies. Epi-pens are kept in a central location at the school that all staff members have access to in case of an emergency.
7. If your child is an asthmatic, you must provide a rescue inhaler and/or inhalation solution to be kept in the Nurse’s Office for emergencies. If your child has asthma, you must return the Asthma Action Plan filled out by your child’s physician.
8. If your child has a history of seizures, you must complete our Seizure Action Plan.
9. The TB Risk Assessment must be completed by all 9th grade students and any Middle or Upper School students who are new to CLS this year. Please let us know if you have any questions.