School Health Risk Assessment Consent Form
Student Information
Full Name
Date of Birth
Grade
Parent/Guardian Information
Parent/Guardian Name
Contact Number
Email Address
Assessment Information
Type of Assessment
Vision
Hearing
Dental
Other
If Other, please specify
Medical History
Please list any relevant medical conditions or allergies
Consent
I consent to my child participating in the school health risk assessment. I understand that the results will be kept confidential and used for school health purposes only.
Parent/Guardian Signature
Date