Link to Connecticut Technical High School System
Bullard-Havens Technical High School, 500 Palisades Avenue, Bridgeport, CT 06610
 
Telephone: (203) 579-6333, FAX (203) 579-6904
Connecticut State Department of Education
 

HEALTH INFORMATION
FROM THE SCHOOL NURSE


SSchool Nurse -Maryann Ciambriello
Tel. (203) 579-6333 ext. 6483

E-mail: Maryann.Ciambriello@ct.gov

Forms
(All of the Forms are in Adobe Acrobat format Download the FREE Adobe Acrobat Reader.)

SPORTS
Important Information about Sports Physical
Note: The Interscholastic Athletics Health History, Permission & Physician’s Release Form must be signed by both parent and student's medical provider. A copy of the most recent physical exam must also be attached and returned to the School Nurse. Interscholastic Athletics Health History, Permission & Physician’s Release Form

Espanol (Spanish)
Importante Nota Sobre Examenes Fisicos de Deportes

Formulario Inter-escolar Atletico con Historial, Consentimiento Paternal y Relevo Medico



GENERAL
Health Assessment Form
Immunization Record
Medical Exemption Form
Medicine Authorization Form
Religious Exemption Form

HUSKY - Healthcare for Uninsured Kids and Youth
- Healthy Children.org