Health Forms

2023/2024 ANNUAL STUDENT HEALTH FORMS

 

Please submit the following annual health records and forms, as needed and indicated by your child’s age and specific health status, prior to your child’s first day of school. Please print the forms from the indicated links, complete, and MAIL (or drop off) to St. Michael’s Country Day School, 180 Rhode Island Ave, Newport, RI, 02840, Attn: School Nurse. Any questions or concerns  may be directed to school nurse Emily Kelleher at ekelleher@smcds.org. Thank you!

DO NOT EMAIL HEALTH RECORDS

  • ALL families – To be completed by a parent or guardian: 2023/24 Annual Student Health History for each student attending St. Michael’s.
  • ALL families please submit the most recent copy of your child’s RI State Physical Exam form including complete immunization record (the doctor completes and signs this form following each annual exam). Print outs of online portal records are NOT acceptable. Forms are current for 1 calendar year. ALL families must sign a Consent for Emergency Treatment
  • All KINDERGARTEN students are required to have a vision exam provided by either their pediatrician, an optometrist or an ophthalmologist, before the end of September 2021. There is a space on the RI physical Exam record for pediatricians to indicate the exam was completed (exams within one calendar year are current). IF this was not completed on your child’s record, or you have any concerns regarding your child’s vision, contact your physician or seek an appointment with an eye care professional.
  • If your child is entering preschool, prekindergarten, or kindergarten the Physical Exam form should include documentation of lead screening (bottom row of assessments on form). If your child is entering 6th, 7th, or 8th grades, the Physical Exam form should include documentation of scoliosis assessment (bottom line of physical exam record) along with updated required immunizations for 7th and 8th graders (HPV). 7th graders also need a vision screening documented on their physical exam form by physician
  • Medication Orders – To be completed by a parent or guardian AND PHYSICIAN for any student who will  need medication at school and/or on a field trip. 2023/24 Medication Orders & Field trip Student Self-Administration Permission
  • Emergency Health Care Plans (EHCP) -to be completed by a physician and signed by parent/guardian (this link is an example form, a doctor’s specific EHCP orders are an acceptable alternative) are required for any student with a diagnosed severe allergy. If your child is in middle school, the doctor must indicate on the EHCP if the student is allowed to self-carry and self-administer their Epi pen.
  • Asthma Action Plan is required for any student diagnosed with Asthma; physicians must indicate if middle school students are allowed to self-carry and self-administer inhalers. To be signed by both physician and parent/guardian.

Please submit this signed form to your child’s previous school so that St. Michael’s Country Day School may receive your child’s official records. If you have any questions, please contact Sandy Merten, Director of Enrollment, at smerten@smcds.org.

School Nurse 401-849-5970 ext. 389

Last Revised 4/2022

The concept of a St. Michael’s community is a big draw for me. It’s not just a place to drop...

1st and 4th Grade Parent

St. Michael's Country Day School
5.0
2019-10-25T09:03:46-04:00

1st and 4th Grade Parent

The concept of a St. Michael’s community is a big draw for me. It’s not just a place to drop off your kids for the day, it’s also the center of the social universe for our family.
My youngest son just joined the PK, and my favorite memory to date is a picture of him balancing on...

Prekindergarten and 2nd Grade Parent

St. Michael's Country Day School
5.0
2019-10-25T09:06:05-04:00

Prekindergarten and 2nd Grade Parent

My youngest son just joined the PK, and my favorite memory to date is a picture of him balancing on a tree stump while doing a tree pose with his eyes closed – love that he’s already learning to “center” himself and grateful for the PK teachers for sending us 
SMS has an extremely supportive and accessible staff and incredibly talented teachers. As a new family in Newport, the school...

Prekindergarten and 2nd Grade Parent

St. Michael's Country Day School
5.0
2019-10-25T09:06:54-04:00

Prekindergarten and 2nd Grade Parent

SMS has an extremely supportive and accessible staff and incredibly talented teachers. As a new family in Newport, the school welcomed up with open arms and made the transition of my then 1st grader seamless. There was also a community of support for him over the summer when he needed 
From the first day of school to the last day of school, my child is HAPPY to go to school....

7th Grade Parent

St. Michael's Country Day School
5.0
2019-10-25T09:07:36-04:00

7th Grade Parent

From the first day of school to the last day of school, my child is HAPPY to go to school. I can remember a project they did in 5th grade about food trucks. The class was presenting in early June, and my son bounced out of bed on presentation day. 
Also, my son loves PE. Mr. Cullen’s games have made my son smarter in terms of strategy and teamwork. He...

7th Grade Parent

St. Michael's Country Day School
5.0
2019-10-25T09:08:15-04:00

7th Grade Parent

Also, my son loves PE. Mr. Cullen’s games have made my son smarter in terms of strategy and teamwork. He feels smarter as an athlete.
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St. Michael's Country Day School

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