Black or African American Sample Clauses

Black or African American. A person having origins in any of the black racial groups of Africa. Terms such as “Haitian” or “Negro” can be used in addition to “Black or African American.”  _________________________

Black or African American. A person having origins in any of the Black racial groups of Africa. 🗆WHITE: A person having origins in any of the original peoples of Europe, North Africa, or the Middle East. _ Signature of Parent/Guardian/Other Date Relationship to Student (please check one box below): 🞎 Mother 🞎 Father 🞎 Guardian 🞎 Other (Specify): See reverse for important message to Parents/Guardians and Confidentiality Procedures and Regulations. HEALTH SURVEY Student Name: D.O.B.: Grade: Family Physician: Phone #: PLEASE COMPLETE THIS FORM INDICATING DETAILS OF ANY MEDICAL CONCERNS RELATING TO YOUR CHILD’S HEALTH. PLEASE BE SURE TO INCLUDE TREATMENT, MEDICATIONS AND DATES. **This information will remain in the health office and will be kept confidential. Your child’s health concerns will only be shared with appropriate staff when it impacts your child’s health and safety.** CONDITION YES NO DETAILS Does your child have hearing or visual difficulties? If so, type of correction. Has your child been diagnosed with a psychological disorder? If so, please indicate medication and dose. Has your child been diagnosed with ADD/ADHD? If so, please indicate medication and dose. Does our child take medication on a regular basis? If so, type and amount. Has your child been diagnosed with diabetes? If so, insulin type and amount. Has your child been diagnosed with epilepsy? Please indicate type. Does your child have a heart murmur or other cardiac condition? Does our child have any kidney condition? Does your child have any breathing problems such as asthma? If so, please indicate treatment. Has your child had any operations? If so, please indicate type and date. Has your child had any serious injuries such as broken bones, head injuries or stitches? If so, please describe and give dates. Is your child allergic to bees or other insects? If so, please give treatment of care required. Does your child have any allergies to food, medication or latex? If so, please describe and give treatment required. Please indicate any other health concerns you have regarding your child. New York State requires immunization records within 2 weeks of enrollment. If this information is not provided within 2 weeks of entrance, your child will be held from attending school until this information is received. Please see the following chart for the current school year, immunization requirements for school entrance. Student Physical: Per New York State Law, a physical must be presented to the school within 30 days o...