FOR SCHOOL NURSE'S MEDICAL FILE: 

AOLG Universal Child Health Record

MEDICATION FORMS:

Authorization for Medication to be Given During School Hours

Self-Administration of Medication form

To Contact the Nurse's Office: (201) 945-1201 Fax Medical Forms: (201) 945-4580
Hours: 8:00am - 2:30pm Monday - Friday

All children in Pre-K through Grade 8 must be up to date with all immunizations required by the State of New Jersey.     

IMMUNIZATION REQUIREMENTS FOR ALL STUDENTS ENROLLING OR ATTENDING ACADEMY OF OUR LADY OF GRACE PRE-SCHOOL

The following vaccinations are required for PreK enrollment at the Academy of Our Lady of Grace:

• 4 D-TaP
• 3 Polio
• 1 MMR
• 4 Hib
• 4 Pneumococcal (PCV)
• 1 VAR of history of Chicken Pox
• Annual Influenza

At least one dose of Pneumococcal Conjugate Vaccine (PCV) is required on or after the first birthday for admittance ro the Academy of Our Lady of Grace.

All Pre-K students must receive one annual dose of Influenza Vaccine between September 1 and December 31.

Any student who has not received their influenza vaccine will be excluded from school beginning January 1.

If uninsured, please check with your local health departments.  Flu vaccines and immunizations may be available.

IMMUNIZATION REQUIREMENTS FOR ALL STUDENTS ENROLLING OR ATTENDING ACADEMY OF OUR LADY OF GRACE KINDERGARTEN

The following vaccinations are required for kindergarten enrollment at the Academy of Our Lady of Grace:

• 5 D-TaP
• 4 Polio
• 2 MMR
• 3 HepB
• 1 VAR of history of Chicken Pox

4 Doses of D-TaP may be acceptable if one dose is received on or after the fourth birthday.

3 Doses of Polio may be acceptable if one dose is received on or after the fourth birthday.

If uninsured, please check with your local health departments.  Immunizations may be available.

IMMUNIZATION REQUIREMENTS OF STUDENTS ENROLLING OR ATTENDING GRADE 6 AT ACADEMY OF OUR LADY OF GRACE

ONE DOSE OF DIPTHERIA, TETANUS TOXOIDS AND PERTUSSIS VACCINE (T dap)

• One dose is needed for every child born on or after January 1, 1997, and entering grade 6. This vaccine cannot be given prior to the child’s 10th birthday. A minimum of 5 years shall have elapsed from the last dose of DTAP/td vaccine in order to receive this booster dose. This also applies to a student turning 11 years of age and attending grade 6. 

ONE DOSE OF MENIGOCCAL VACCINE

• One dose is needed for every child born on or after January 1, 1997, and entering grade 6. This also applies to students turning 11 years of age and attending grade 6. Your child must complete these immunizations before school starts unless his birthday is after school starts: in which case, a student can attend school until they turn 11 years of age.

Asthma Treatment Plan Form 

Food Allergy & Anaphylaxis Emergency Care Plan

Health History Update Questionnaire

In School Medication Authorization Form

Medication Self Administration Form

Permission to Carry Epi-Pen Form

Pre-participation Physical Evaluation form