Health Screening Consent Form
Dear Parent or Guardian,
In an effort to better address the health needs of students, the State of Tennessee requires that throughout the 2008-2009 school year, the Hamblen County school system must screen all students in the K, 2, 4, 6, 8, and 9thgrades. Trained school nurses and health care personnel will complete all screenings with strict adherence to confidentiality of each child and adolescent screened. Please note there will be no charge for these services. The screenings will include:
- Height
- Weight
- Blood Pressure
- Vision
- Hearing
Kellie C. Smith, M.P. H.
School Health Coordinator
423-587-5316
ksmith@hcboe.net
PLEASE PRINT THE BELOW ATTACHED ORIGINAL SCHOOL SCREENING CONSENT FORM (DO NOT PRINT THIS WEB PAGE).
___Height ___Weight ___Blood Pressure ___Vision ___Hearing
Child’s Name: ____________________________________________________
Parent or Guardian’s signature: _______________________________________
Date: ___________________________________________________________