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Application

Student Info

Student Name
Student Name
First
Last
Address
Address
City
State/Province
Zip/Postal

Medical History

Past Diseases
Recent Disabilities
Are there other health problems and/or handicaps present?
Is your child currently under a physician's care?
Does your child have a condition that currently or periodically restricts his/her physical activity?
Has your child been evaluated by a physician for this condition?
Does your student need medication for any condition?
Does the student receive this medication at home?
Does the student need to receive this medication at school?
All medication brought to school must be brought to the office. Medication must be in a properly labeled bottle with the name of the medication, dosage, frequency, and doctor's name.
Is medication needed for the allergy at home?
Is medication needed for the allergy at school?
Personality of Student
I agree to authorize this school to employ such discipline as outlined in the FNCS Student Handbook and as it deems wise and expedient for my child. I also have read, understood, and agreed to all accompanying attachments to this FNCS student application for enrollment.