Student Information:

Please list medications and dosage schedule below for any medications your child is taking, including those for asthma/allergies. 

If your child's medications include anything that must be injected in case of an emergency (ex: Epi-Pen), you must bring one to the JLC office clearly labeled with your child's name, physician information, and dosage instructions. It will be returned at the end of the year. 

Please tell us about your child:

Learning Needs

Tutoring

Behavioral and Social/Emotional Needs

IEP/504

Religious School Experience

Strengths

Challenges

Strategies

Expectations

Specialists or Professionals

Parental Signature