Health and Safety

Student Health Information 

Student Health History

Please complete a Student Health History Form for EACH child attending Ignite if you'd like to make us aware of any health concerns or considerations. 

Child lives with

MEDICAL HISTORY

Yes/No: Has your child ever had (if yes, please describe.)

MEDICAL HISTORY

Yes/No: Has your child ever had (if yes, please describe.)

Any Serious Allergies?
Ashtma/Breathing problems
Orthopedic or Bone Problems
Heart Disease or Murmur
Kidney Disease
Seizures
Diabetes (insulin Dependent? Insulin pump?
Serious or Chronic Disease
Chickenpox
Serious Accident/Injury
Other

MEDICATION

Is student on special medication that may need to be administered during school hours?

If yes, an authorization must be completed by parent/guardian AND child's physician and returned to the school before any medication can be administered.  Please visit the main office for the appropriate form. All authorized medication is administered by a designated professional. It is a violation of Ignite's Drug-Free school policy for students in grades K-8 to carry medication with the exception of inhalers, epinephrine injectors, and insulin (with completed authorization with parent/guardian and physician signatures).

Authorization to Administer Ibroprofen and/or Tylenol

Tylenol (acetaminophen) or Motrin (ibuprofen) may be administered at school only if prior parent(s)/guardian(s) permission has been given through this signed Student Health Information form. Providing this written parent(s)/guardian(s) permission has been given, designated school personnel may give acetaminophen or ibuprofen to students with the following symptoms: fever (100 degree F or above) after the parent(s)/guardian(s) has been notified to pick up their student, dysmenorrhea (menstrual cramps), headache, or toothache.

Consent for Tylenol/Ibuprofen

Address:

Ignite Academy
1650 W Traverse Terrace Dr
Lehi, UT 84043-5994

Email: info@igniteutah.org

Phone: (801) 901-8520

Fax: (801) 901-8515

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