Link to Connecticut Technical High School System
Emmett O'Brien Technical High School 141 Prindle Avenue, Ansonia, CT 06401
 
Telephone: (203) 732-1800, FAX (203) 735-6236

Connecticut State Department of Education

 

HEALTH INFORMATION
FROM THE SCHOOL NURSE

Susan Hoffert

 

 

 

School Nurse - Sue Hoffert
Telephone: (203) 732-1800 ext. 830
E-mail: Sue.Hoffert@ct.gov

Forms
(All 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


GENERAL
Health Assessment Record (HAR3)
Immunization Record
Medical Exemption Form
Medicine Authorization Form
Religious Exemption Form

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