Annual Health Update Form

Please submit the following forms by Friday, September 11th, 2020. For new families to St. John School, please submit online upon enrollment. Thank you for cooperation.

If you have any questions, please contact Nurse Nancy Macleod at (860) 388 0849. 

First & Last Name

If medication is to be given during school, an AUTHORIZATION FOR ADMINISTRATION OF MEDICINE BY SCHOOL PERSONNEL FORM must be completed yearly and on file in the school health office. See form online.

Medication Name


Doctor's Name

Please list dates if more than one Immunization/Booster


NON-PRESCRIPTION MEDICATIONS/TREATMENTS may be required to help relieve symptoms related to minor conditions such as poison ivy, cuts, scrapes, chapped lips, etc. Please indicate which of the available non-prescription drugs/treatments MAY NOT be used or given by checking the appropriate boxes on the enclosed list. 


All OTC non-prescription drugs/treatments are approved. A Registered Nurse (RN) is always available at the school to assist in the assessment of the student's conditions and to respond appropriately in dispensing these medications/treatments. Nicholas Condulis, M.D., F.A.A.P., the Medical Advisor for Old Saybrook Public Schools, has approved the non-prescription drugs/treatments listed for use at school and we will have these in stock in our Health Office.


Parent/Guardian First & Last Name