Grade of child

Do you have medical information to report:

Allergies: Please check all the allergies that your child has:
(Use your Ctrl & Shift keys to select multiples)

Please list the severity and describe/specify the allergic reaction to the allergies selected above:

Has your child been prescribed an Epi Pen?

If so, then where specifically will it be located?
*** It is YOUR RESPONSIBILITY to provide an Epi Pen for your child. We DO NOT keep an Epi Pen on site!

Medical Conditions: Please list all medical conditions your child has that we should be aware of. Please do not ask an advisor to give medication to your child - all medication (including over-the-counter) must be administered by the parent (except for an Epi Pen in an emergency).

Learning Disabilities/Challenges: Please check any of the following that apply to your child:
(Use your Ctrl & Shift keys to select multiples.)

Please list any medications and things we need to know about the learning disabilities/challenges listed above:
(Please give specific details about accomodating your child's learning challenges that may be helpful to our advisors. Please keep in mind that we are not an educational institution. While it is our goal to foster a positive learning environment for all students, we may not be equipped to provide accomodations necessary to facilitate every child's learning needs. Should your child need more in-depth or specific learning accomodations that we cannot provide, we may recommend that you seek more customized resources through other organizations. Please contact our LIFE Classes Coordinator at hphelcc@gmail.com if you have any questions or concerns.)

Behavior Challenges/Difficulties:
(Please list any behavioral challenges or difficulties that have not been addressed above. Our priority is to provide a safe learning environment for all students. If your child has behavioral challenges, whether medical or non-medical, participation in our LIFE classes must be approved to ensure that the safety of all participants is not jeopardized. Please contact our LIFE Classes Coordinator at hphelcc@gmail.com prior to submitting your registration to make sure HPHE is equipped to handle any accommodations your child might need.)