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Douglas County School District JLCB-E-1 2012-2025 free printable template

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Superintendent File: JLCDE1 DOUGLAS COUNTY SCHOOL DISTRICT Re. 1 SCHOOL HEALTH SERVICES STUDENT MEDICATION REQUEST AND RELEASE AGREEMENT This form must be completed for any medication (prescription
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01
Obtain a copy of the Douglas County School District JLCB-E-1 form.
02
Read the instructions carefully to understand the required information.
03
Fill in the student's name and date of birth at the top of the form.
04
Provide the parent's or guardian's name and contact information.
05
Fill in the details regarding the student's medical history, including any allergies or chronic conditions.
06
Indicate any medications the student is currently taking and any necessary dosage information.
07
Sign and date the form at the bottom to confirm the information is accurate.
08
Submit the completed form to the appropriate school representative or designated office.

Who needs Douglas County School District JLCB-E-1?

01
Parents or guardians of students enrolling in Douglas County School District.
02
School health personnel managing student health needs.
03
Administrative staff responsible for maintaining student health records.
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Douglas County School District JLCB-E-1 is a form used by the Douglas County School District to report and manage information related to student health and immunization compliance.
The form JLCB-E-1 is typically required to be filed by parents or guardians of students, as well as school officials, to ensure that student health records are maintained in accordance with district policies.
To fill out the JLCB-E-1 form, individuals must provide student identification information, details about immunizations, and any health-related exemptions or special needs in the designated sections of the form.
The purpose of the JLCB-E-1 form is to ensure compliance with immunization laws and health regulations, to protect the health of students, and to assist the district in maintaining accurate health records.
The information that must be reported on JLCB-E-1 includes the student's name, birthdate, vaccination history, any exemptions, and contact information for the parent or guardian.
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