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Cantiague Elementary School
George A. Jackson Elementary School
Jeffrey Ratner Robert Seaman Elementary School
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Jericho Middle School
Jericho Union Free School District
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Health Office Forms
Medications in School
Attestation Form
At the MS and HS level, if a student is going to self-carry and self-medicate, the Attestation Form must be completed and submitted to the health office.
Please return or
E-mail
completed form to the school nurse.
Medication Authorization Form
A NYS healthcare provider must fill out the Medication Authorization form for all medications to be given in school, including over the counter medications.
All medications must be provided in original packaging.
All medications including over the counter and prescriptions, must be delivered to the health office by a parent or designated adult.
Please return or
E-mail
completed form to the school nurse.
Form Instructions for Printing