Health Office Staff
Jean Hammond, RN-School Nurse
Berlin Central School District
Phone – (518) 658-1500 ext. 308
Fax – (518) 658-0482
Email – email@example.com
Health Office Forms/Policies
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2019-2020 Immunization Requirements
2019 Religious Exemption Amendment
2019 Religious Exemption Note from Health office (the note attached)
2019-2020 ACIP catch up immunization schedule
Emergency cards are kept in the Health Office and used to contact parents or other individuals in the event of student illness or injury. Please notify the Health Office whenever there are changes to your emergency contact information. Additional cards are available from the Health Office or under the forms link on the right-hand column of this page.
In accordance with NY State Law, the Health Office must require a signed written order from each student’s private physician to dispense any over the counter or prescription medications. Students must also have written consent from a parent or guardian. Forms for written consent are available from the Health Office or under the forms link on the right-hand column of this page.
SWISH (Sodium Fluoride) Program – Grades 1-12
Berlin Central School and the New York State Department of Health offers a fluoride mouth-rinse program to help reduce dental decay. Participation is voluntary and without cost to you. Parental consent is required. SWISH Consent Forms for the SWISH Program are available from the Health Office or under the forms link on the right-hand column of this page.
All students playing sports must have a physical examination by the School Physician. Private examinations are not acceptable for participation in sports. A INTERVAL HEALTH HISTORY FORM FOR SPORTS PARTICIPATION must also be completed by the parent and student prior to the start of each new sports season to be eligible to participate in practice/games. Students sign up for a new sport by completing and returning a Sports Health History Form. Sports forms are available from the Health Office, the coaches or under the forms link on the right-hand column of this page.
Parent Athlete Concussion Information Form
The Berlin Central School District, as part of their Concussion Management Program, requires student athletes and their parents to receive information about concussions. All athletes and their parents must read this form and then sign and return it to their coach or the Health Office prior to the athlete participating in any extracurricular sports.