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Cantiague Elementary School
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District
Schools
Cantiague Elementary School
George A. Jackson Elementary School
Jeffrey Ratner Robert Seaman Elementary School
Jericho High School
Jericho Middle School
Jericho Union Free School District
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Health Office Forms
Medical Accommodation
Medical Accommodation Form
This form is to be completed by your child’s healthcare provider to request any specific accommodations that are needed at school due to a medical condition.( for example: need for wheelchair, prolonged gym/recess exemptions, transportation accommodations).
Once this form is completed and submitted to your school nurse it will be sent to the district’s school physician for review and needed approval.
Please return or
E-mail
completed form to the school nurse.
Form Instructions for Printing