WESTLAKE HIGH SCHOOL

Healthcare Science Academy

PROGRAM HANDBOOK
Committed to Building a Pipeline o !uture
Healthcare Proe""ional"#
$""ential" o Healthcare
Dear Students, Parents/Guardians,
Welcome to the Healthcare Science program here at Westlake High School. The goal of this program is to
inform our students on the organization, opportunities and skills related to the Healthcare field. This first year of
the program is designed to teach the students alua!le professional skills.
The second year of the program is ne" this year# The students are taking a class called $pplied Therapeutic
Science or %ssentials of Healthcare. This is !asically an anatomy class# The students "ill learn alua!le
information a!out anatomy and physiology that "ill help them e&cel in their upper leel classes#
'areers in Healthcare proide a serice that "ill al"ays !e needed. These (o!s re)uire people taking care of
people. *t takes a ery special person to dedicate their talent and skills to care for the sick and in(ured. %en "ith
all of the current technology and adancements in the medical field, %$ are still the primary care proiders!
* "elcome you to (oin this (ourney as "e e&plore the Healthcare arena, and !egin to+
&a'e care o the (orld))#
Sincerely,
*la $nderson, ,S, $T'/-$T
Healthcare Science Teacher
Head of
Westlake High School
./0/1 2/343/00
Email: $nderson*%5fultonschools.org
We!6 http://healthcarewithanderson.weebly.com
Westlake HOSA Information
H7S$ .H7S$1 is a national student organization endorsed !y the 8.S. Department of
%ducation and the Health Science Technology %ducation Diision of $'T%. H7S$9s
t"o4fold mission is to promote career opportunities in the health care industry and to
enhance the deliery of )uality health care to all people. H7S$9s goal is to encourage
all health occupations instructors and students to (oin and !e actiely inoled in the
HST%4H7S$ Partnership.
H7S$ proides a uni)ue program of leadership deelopment, motiation, and
recognition e&clusiely for secondary, postsecondary, adult, and collegiate students
enrolled in HST% programs. H7S$ is :00; health care#
Since its inception in :<=3, H7S$ has gro"n steadily reaching oer 1!"!!! mem!ers through #$ chartered H7S$ State
$ssociations and appro&imately /,>00 secondary and postsecondary/collegiate chapters in ?0:04?0::.
H7S$ is not a clu! to "hich a fe" students in school (oin. @ather, H7S$ is a po"erful instructional tool that "orks !est
"hen it is integrated into the HST% curriculum and classroom. HST% instructors are committed to the deelopment of the
total person. Those "ho (oin the HST%4H7S$ Partnership recognize the importance of proiding students "ith training far
!eyond the !asic technical skills needed for entry into the healthcare field. The rapidly changing health care system needs
dedicated "orkers "ho, in addition to their technical skills, are people4oriented and capa!le of playing a leadership or
follo"er4ship role as a mem!er of a health care team.
HOSA%s mission is especially critical when considerin& the ac'te shorta&e of ('alified workers for the health care
ind'stry. *t is essential that the HST%4H7S$ Partnership maintain its momentum and encourage all HST% instructors to
integrate H7S$ into their curriculum and classrooms.
Westlake H7S$ has !een around for :0 years. Westlake H7S$ is a Aationally recognized 1!!/1!! or&ani)ation. Which
means e*eryone is a mem!er and all dues are collected on time. H7S$ is part of the studentBs curriculum at the Cederal,
State and 'ounty leel and part of their grade. -ast year Westlake H7S$ "ent to @egional competition, State competition
and Aational competition in $naheim, 'alifornia+++
Participation in H7S$ actiities such as attending the monthly meeting is "orth ?0 points. Wearing the appropriate dress on
Professional Wed. or Scru!/DD8 Thur. can also gie the student H7S$ points. Participation in after hour actiities, such as
H7S$ conferences, olunteering at the EToys Cor TotsF "arehouse and !lood dries counts ?0 points per day. Students can
earn as many points per semester as they "ant. They record their participation on their H7S$ sheet. -oss of the H7S$ sheet
"ill result in a )ero grade for i*e percent of their semester grade. A st'dent cannot participate in HOSA acti*ities 'nless
they are a HOSA member. ++We have an introductory meeting on &ue"day, Augu"t -., -/01.
The meeting will start at 2314 pm in the Auditorium and will last 0 5 hours.
,eetin& -imes: .ast -'esday of each month" after school" in the A'ditori'm.
7ccasionally "e might hae to change or hae unscheduled meetings. Decem!er and ,ay "ill hae different dates
and locations .
/'es: HOSA is 01!.!! per student. This includes Aational, State and @egional mem!ership for the school year.
Students "ith a financial hardship should see ,s. Pey to make arrangements. $ll dues paid !y A'&'st 2" !1#
"ill receie a discount of 03.!!. $-- dues "ill need to !e paid !y October $" !1#.
Ad*isors: ,s. Pey, ,s. Harris, ,s. $nderson, ,s. Thornton ./0/1 2/343/00, e&t 123
Healthcare Science Technology Education
GRADING SYSTEM
45A/I64 S7A.E
2!81!! 9 A :!8:29 ; $!8$29 7 <2 and below 9 =
-ests 9 13>
7lass Assi&nments/ Homework 9 1!>
Work Ethics 9 13>
HOSA 9 3>
=inal E?am 9 13>
1. @erformance ;ased" A7lass participation/ Work EthicBG:>>
This grade is !ased on demonstrated a!ilities on performance, la!oratory checklists
and employa!ility. The student "ill automatically hae :00 points daily in this area.
The student "ill !e gien one Work %thic Grade Sheet per Semester. *f the student
loses this form they "ill receie a A!B there "ork ethic grade. Deducted points "ill !e
!ased on some of the follo"ing.
:. Collo"ing instructions =. %fficient use of time
?. Promptness .tardiness1 H. Working "ell "ith others
2. Safe "ork ha!its <. Honesty
/. Dependa!ility :0. Proper use of tools and e)uipment
>. Proper dress ."hen re)uired I dictated !y school/dept. policy1
3. @espectful attitude for self, e)uipment and others
1. HOSA Acti*ities represent 3> of the Semester grade. $ll HST% students "ill (oin
H7S$ and all clinical students must also (oin Health %&plorers for insurance
purposes. $ll students "ill need to participate in H7S$ actiities to enhance their
leadership skills.
2. -he =inal represents 13> to"ard the final grade at the end of the semester.
JJ-$T% P7-*'KJJ -ate "ork "ill only !e accepted on the ne&t calendar day after
the due date of the assignment. The highest grade that the "ork "ill receie "ill !e a
3H;.
*f the "ork is not turned in, it "ill !e marked as an AH* .Aot Handed *n1 "hich is
"eighted as a 0;
Work %thics sheets are due at the end of %L%@K W%%M. *f they are not turned in or
missing the "eekly aerage it "ill !e considered a zero. *f the student turns in the
"ork ethics sheet the follo"ing ,onday the highest grade that they can receie is a
3H;.
Course Name: Applied Therapeutic Science (Essentials)
Course Number: 3.#!!!!
Westlake High School
Teacher(s): Ila E Anderson
!S" ATC
#hone Number: !ailbo$ %: &'&()&*(*&''
+oom Number: ,*-
Email: .estlakesportsmed/gmailcom
Website: http://healthcarewithanderson.weebly.com
0ear: ,'1)(,'1& Tutorial 2a3s: Wednesda3 or b3 appointment
Te$tbook: Tutorial Hours: 4:)'am(5:16am
Te$tbook #rice: Tutorial 7ocation: +oom ,*-
Course 2escription:
Anatomy and Physiology is a vital part of most healthcare post-secondary education programs. The Essentials of Healthcare
is a medical-focused anatomy course addressing the physiology of each body system, along with the investigation of
common diseases, disorders and emerging diseases. The prevention of disease and the diagnosis and treatment that might
be utilized are addressed, along with medical terminology related to each system. This course provides an opportunity to
demonstrate technical sills that enforce the goal of helping students mae connections between medical procedures and the
pathophysiology of diseases and disorders. The pre-re!uisite for this course is "ntroduction to Healthcare.
Course #rere8uisites: no prere8uisite
9E:+9IA #E+;:+!ANCE STAN2A+2S or CC9#S :
9+A2IN9 #:7IC0: A=100-90 B=89-80 C=79-70 =!9 A"# B$%&'
9+A2IN9 SCA7E
Area #ercentage
Classwor(/Assi)nments *0+
'or( $thic 1,+
-ests/Assessments *,+
.&/A ,+
inal $0am 1,+
C:<+SE :<T7INE=: Semester 1
=This course outline ma3 be ad>usted and or modi?ied b3 the instructor as needed
Week 1: #rientation to Essentials Week 10: $espiratory %ystem
Week 2:
&asic structural and functional
organization of the human body '
(edical Terminology
Week 11: $espiratory %ystem
Week 3:
&asic structural and functional
organization of the human body '
(edical Terminology
Week 12: $espiratory %ystem
Week 4: "ntegumentary %ystem Week 13: Pro)ect
Week 5: "ntegumentary %ystem Week 14: (uscular and %eletal %ystem
Week 6: *ardiovascular Week 15: (uscular and %eletal %ystem
Week 7: *ardiovascular Week 16: (uscular and %eletal %ystem
Week 8: *ardiovascular Week 17: $eview
Week 9: *ardiovascualar Week 18: (id Term
C:<+SE :<T7INE=: Semester ,
=This course outline ma3 be ad>usted and or modi?ied b3 the instructor as needed
Week 1: +rinary %ystem Week 10: Endocrine %ystem
Week 2: +rinary %ystem Week 11: Endocrine %ystem
Week 3: $eproductive Week 12: ,igestive %ystem
Week 4: $eproductive Week 13: ,igestive %ystem
Week 5: -ervous %ystem Week 14: .ymphatic %ystem
Week 6: -ervous %ystem Week 15: .ymphatic %ystem
Week 7: -ervous %ystem Week 16: .ymphatic %ystem
Week 8: -ervous %ystem Week 17: $eview
Week 9: Endocrine %ystem Week 18: /inal
+E@<I+E2 !ATE+IA7S:
*-rin) binder
pen/pencil
paper
di1iders with tabs
Notebook Sections:
1. GPS - complete with essential questions (EQ) for every standard (written neatly)
. !lasswor"#$otes- "eep all assi%nments completed in class and your notes in this
section
&. 'edical 'inute- (eep every warm-up in this section
). *eturned +or"- you MUST "eep all returned wor" in this section in your ,inder. +e
have a hole puncher in class for you to ,e a,le to put everythin% in the ,inder
C7ASS+::! EA#ECTATI:NS:
+e?er to Work Ethic Sheet
C:NSE@<ENCES:
In the eBent that students do not uphold classroom e$pectations" progressiBe discipline .ill be en?orced b3 an administrator
7ATE ASSI9N!ENTS #:7IC0:
*f you are present "hen an assignment is gien, then * e&pect you to turn in the "ork on the day that it is due.
*f you hae an e?c'sed a!sence on the day it is assigned, then you "ill hae one day to turn the assignment in "ithout penalty.
*f you hae an 'ne?c'sed a!sence on the day the assignment is due you are not entitled to make up that assignment and "ill
receie a grade of zero. *f you miss a test, you must make up the test after school "ithin > days of your return to school. .-ate
policy su!(ect to change for Performance $ssessments1.
!ACE(<# #:7IC0:
.ate Assi&nments/,ake8'p Work:
$ssignments are to !e turned in at the be&innin& of the class period on the day the "ork is due !y placing the "ork in the
appropriate !in. Cor eery day that the assignment is late, 1! percent "ill !e ded'cted from the assignment grade do"n to a
=0;. $fter the /th day the student "ill receie a C6HID A6e*er Handed InB 9 !>" if the assignment is still uncompleted. *f
the assignment is not handed in "ithin 2 days upon return to school, after these / days a grade of C.1>D is gien. *n the case of
an e?c'sed absence, make4up class "ork, )uizzes, home"ork, and tests must !e completed "ithin 2 days upon return or during
scheduled make4up sessions. Students are responsi!le for o!taining class notes and assignments. $s stated in the student
hand!ook, Elong-term assignments are expected to be completed and turned in on the assigned due date.
In the case of 'ne?c'sed absences" a st'dent will not be allowed to make8'p any &raded work. =or more information"
refer to the Ene?c'sed Absences policy listed in the st'dent handbook.
+EC:DE+0:
Proision for *mproing Grades
:. 7pportunities designed to allo" students to recoer from a lo" or failing cumulatie grade !ased on the student print
out gien !y the teacher eery three "eeks "ill !e allo"ed "hen all "ork re)uired to date has !een completed . A7
AH*1 and the student has demonstrated a legitimate effort to meet all course re)uirements including attendance "hich
includes fie une&cused a!sences including three une&cused tardies "hich e)uals one a!sence. Students should contact
the teacher no more than three days after an assignment concerning recoery opportunities after receiing a printout
from the teacher. Teachers are e&pected to esta!lish a reasona!le time period for recoery "ork to !e completed
during the semester. $ll recoery "ork must !e directly related to course standards and o!(ecties and must !e
completed ten school days prior to the end of the semester.
?. Teachers "ill determine "hen and ho" students "ith e&tenuating circumstances may improe their grades.
TA+2INESS:
TA+20 C:NSE@<ENCES
/t2dents who arri1e late to class and school may be s2b3ect to the 4ollowin) conse52ences:
C2m2lati1e -ardies 67er /emester8 Conse52ence
1-* -ardies 'arnin)
9-! -ardies A4ter-school detention
7-9 -ardies /at2rday school/://
10; -ardies <eport to :// 4or remainder o4 period= :///&//

<SE :; E7ECT+:NIC 2EDICES:
Cell phones cannot be on or 1isible 2nless a2thori>ed by the teacher 4or instr2ctional p2rposes.
HA77 #ASS:
EACH ST<2ENT IS 9IDEN ) HA77 #ASSES A SE!ESTE+ ;:+ EITHE+ THE EATH+::! :+ 7:CCE+ ST<2ENTS A+E
N:T #E+!ITTE2 T: F+<N E++AN2SG 2<+IN9 !0 C7ASS
#+ESENTATI:N :; ASSI9N!ENTS:
-eacher 'ebsites
?erbal Comm2nication
7osts in Classroom
C7ASS+::! 2+ESS C:2E (7AE" #E" 2ANCE" +:TC" ETC)
&n lab days st2dents m2st be in appropriate athletic apparel@ shorts and t-shirts with athletic shoes. /t2dents will be )i1en notice
when this dress code is e0pected.
/ee 'estla(e .i)h /chool handboo( 4or school dress code
A2idelines 4or .&/A attire: 'ednesday 67ro4essional dress or .&/A polo and slac(s8@ -h2rsday 6scr2bs or .&/A t-shirt8
WEST7ACE HI9H SCH::7 H:N:+ C:2E:
The Westlake High School Honor Code is in effect at all times. Cheatin) will not be toleratedB
Cheatin) is de4ined as )i1in) or recei1in) in4ormation in any 4orm that is related to a )radable e0perience incl2din) the 2se o4 so2rces o4
in4ormation other than those speci4ically appro1ed by the teacher either d2rin) or o2tside o4 class. /t2dents are re52ired to si)n honor
pled)es as applicable 4or ma3or tests@ pro3ects@ and/or papers.
$0amples o4 Cheatin) incl2de@ b2t are not limited to:
#lagiarism H 2sin) words or ideas 4rom a p2blished so2rce witho2t proper doc2mentation= 2sin) the wor( o4 another st2dent 6e.).
copyin) another st2dentCs homewor(@ composition@ or pro3ect8= 2sin) e0cessi1e editin) s2))estions o4 another st2dent@ teacher@
parent or paid editor.
7ooking on someone elseIs paper during a test or 8uiJ
Cheat sheets o? an3 kind
Cno.ingl3 accepting or giBing in?ormation concerning the contents o? a test or 8uiJ
Changing the appearance o? computer printouts
Allo.ing another student to complete Web Assign or other .eb(based actiBities using 3our name and login in?ormation
Any st2dent 4o2nd to be in 1iolation o4 the .onor Code on any assi)nment will recei1e a )rade o4 a >ero on the assi)nment in 52estion. -he
assi)nment may not be made 2p 6st2dents ha1in) >eros are not eli)ible 4or reco1ery8. ?iolations may be considered by 4ac2lty in ma(in)
42t2re recommendations. Demberships in honor cl2bs will be 3eopardi>ed.
N:TE T: #A+ENTS:
$ny additional )uestions or concerns, please see your program specific hand!ook.
Intro to Healthcare Science Syllabus ecei!t
Conirmation and Contact Sheet
" acnowledge and have read all of the information contained in this syllabus 0pgs.1-23 and will wor with my
daughter4son4parent4guardian4teacher to successfully complete this course.
%tudent -ame 0print35666666666666666666666666666666666666666666666666
Parent0s347uardian0s3 -ame 0print356666666666666666666666666666666666666
Parent0s347uardian0s3 %ignature5666666666666666666666666666666666666666
Parent0s347uardian0s3 E-mail Address 0if
applicable356666666666666666666666666666666666666666666666666666
Parent0s347uardian0s3 ho"e !hone nu"ber566666666666666666666666666666
Parent0s347uardian0s3 #ork !hone nu"ber5666666666666666666666666666666
Parent0s347uardian0s3 cell !hone nu"ber56666666666666666666666666666666
Alternate contact number 0if applicable35666666666666666666666666666666666
At 8estlae High %chool, we understand that you have busy schedules and respect your time. Therefore,
we guarantee that we will not abuse any of the given information and will contact you only when necessary
0usually under the conditions outlined in the syllabus or to let you now information that is pertinent to your
student9s success at 8estlae High %chool3. All information is re!uired to consider this form complete. A
mass e-mail may be sent or a courtesy call may be given to ensure that the information provided is
accurate.
"f you wish to contact me or set up a conference you can call the counselors office and the secretary will
mae an appointment that meets your convenience. The best way to contact me directly is to e-mail me at5
westlaesportsmed:gmail.com
;ou can also visit the class website at5
http544healthcarewithanderson.weebly.com
PO67C8 ON ABS$NC$S
'lass policy on a!sences is as follo"s6
*f a student has an e?c'sed a!sence, they must notify the attendance clerkN then present the
teacher "ith the appropriate documentation. $ny "ork or assignments due for that day
mu"t !e made up "ithin 1 school days from the day of return.
JThe !ook report is d'e re&ardless of absence. This is a long4term assignment that
the student can turn in early or email in case of a!sence.
*f there is an 'ne?c'sed a!sence, any "ork or assignments due for that day "ill !e counted
as a zero, .01.
School policy "ill oerride any classroom policy on a!sences.
444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444
&OO69S:PP68 CH$CK;O:& S8S&$M
Ao tools, supplies or ideos "ill leae the classroom "ithout the teacherBs authorization.
8pon authorization !y the teacher, students "ill sign a checkout oucher and the item must
!e returned "ithin the designated time frame allo"ed.
'H%'M78T L78'H%@6
Westlake HS-E 7HE7FOE- GOE7HE5
6A,E: HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH
/A-E: HHHHHHHHHHHHHHHH 7.ASS/@E5IO/: HHHHHHHHHHHHHHHHHHHHHHHHH
I-E, 7HE7FE/ OE-: HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH
7O6/I-IO6 O= I-E,: HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH
/A-E -O ;E 5E-E56E/: HHHHHHHHHHHHH /A-E 5E-E56E/:HHHHHHHHHHHH
7O6/I-IO6 O= I-E, WHE6 5E-E56E/:HHHHHHHHHHHHHHHHHHHHHHHHHHHH
-EA7HE5 7O,,E6-S:HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH
%$S&6AK$ H7GH SCHOO6
Healthcare Science -echnolo&y Ed'cation
$lass $on%uct $o%es
0<= De on time, prepared and ready to "ork.
-<= @espect yourself, others and the e)uipment at all times
2<= Treat others the "ay you "ant to !e treated in their situation.
1<= *nappropriate talking during lecture is not permittedN @aise you hand##
4<= Students are not permitted to use e)uipment unless instructor is present.
Ao la! time "ith a su!stitute teacher.
.<= 'lean up your o"n mess###
St'dent Si&nat'reHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH /ate: HHHHHHHHHH
@arent/4'ardian Si&nat'reHHHHHHHHHHHHHHHHHHHHHHHHHHHH /ate: HHHHHHHHHH
WESTLAKE HIGH SCHOOL
Healthcare Science -echnolo&y Ed'cation
LABORATORY AGREEMENT
*t is my understanding that as a Parent/Guardian of a Healthcare Science Student, if there is
anything apparently "rong "ith the e)uipment or supplies to "hich the Student has !een
assigned, the Student is to notify the *nstructor immediately.
*, .the Parent/Guardian1 shall !e responsi!le for the repair or replacement cost of any
damaged e)uipment/supplies through the sole negligence of my Student.
* also understand that if my Student fails to notify the *nstructor of damaged e)uipment
prior to the start of an assignment, * am responsi!le for the repair or replacement cost of
said e)uipment.

@arent/4'ardian Si&nat'reHHHHHHHHHHHHHHHHHHHHHHHHHHHH/ateHHHHHHHHHH
Student SignatureOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOODateOOOOOOOOOO
Instr'ctor Si&nat'reHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH/ateHHHHHHHHHH
H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H
,edia 5elease @ermission =orm
*, OOOOOOOOOOOOOOOOOOOOOOOOOOO, state that * am the parent/legal guardian of
OOOOOOOOOOOOOOOOOOOOOOOOOOOOO, a student at Westlake High School. * gie
permission for the follo"ing .please check and initial16
P OOOOOOOO Photos taken as part of the course may !e used for community pu!lication. * gie
permission to use my childBs picture for these locations6 School ne"spaper, local
or national ne"spapers, school, state D7%, G$ H7S$, Aational H7S$, and/or
dept. "e!site.
POOOOOOOO Lie" the follo"ing films "ith a PG or PG4:2 rating that are related to su!(ect
studied6 7ut!reak, ,y -ife, SuperSize ,e. 7ther films "ill !e announced.
P OOOOOOO Lie" any media center or class ideo related to6 STDs, Teen Pregnancy, sports in(ury etc. as
related to class
@arent/4'ardian Si&nat're:HHHHHHHHHHHHHHHHHHHHHHHHHHHHH/ate:HHHHHHHH
Westlake High School
Healthcare Science &echnology $ducation
Parent/Guardian Agreement
7>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>, the parent9guardian o!
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO, the st'dent, hae read the Healthcare Science
Technology %ducation hand!ook and understand all policies that my student must adhere
to in order to complete the HST% or Cirst @esponder program. * also understand that my
student "ill !e discussing and isualizing the human !ody as it relates to medicine and
science. * am fully a"are that this may include some graphic material.
Parent9Guardian SignatureOOOOOOOOOOOOOOOOOOOOOOO Date6OOOOOOOOO
4444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444
St'dent A&reement
*,OOOOOOOOOOOOOOOO, a st'dent in the Healthcare Science Technology %ducation
program at Westlake High School, ackno"ledge the receipt of the HST% Hand!ook. * hae
also read the hand!ook and agree to a!ide !y all policies contained "ithin the hand!ook
and any other related school, county, state or country policies.
Student SignatureHOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO Date6OOOOOOOOOOOOO
WES-.AFE HS-E !1#8!13
Emer&ency 7ontact I /ata Sheet

Student"s #ame$ Phone:( )___________D.O.B. ______

Address$OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO%ity$ State$ &ip$''''''''
(other"s #ame$''''''''''''''''''''''''''''''''''''''''''''' Home )hone$'''''''''''''''
%ell )hone''''''''''''''''''''''''''' Wor* )hone''''''''''''''''''''''''''
(other"s Email$'''''''''''''''''''''''''''''''''''''''''''''''
+ather"s #ame$''''''''''''''''''''''''''''''''''''''''''''' Home )hone$''''''''''''''''
%ell )hone''''''''''''''''''''''''''' Wor* )hone''''''''''''''''''''''''''
+ather"s Email$'''''''''''''''''''''''''''''''''''''''''''''''
,uardian"s #ame$'''''''''''''''''''''''''''''''''''''''''' Home )hone$''''''''''''''''
%ell )hone''''''''''''''''''''''''''' Wor* )hone''''''''''''''''''''''''''
,uardian"s Email$'''''''''''''''''''''''''''''''''''''''''''''''
Dest Times for us to contact you6OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

JJ7 (e can?t reach you in an emergency3
$mergency Contact Name3>>>>>>>>>>>>>>>>Relation to "tudent3>>>>>>>>>>>>>>>>>
%mergency Phone6 N 'ell OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
Student?" Doctor" Name @ NumAer3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
StudentBs ,edical History6 .Please include any $llergies and any current medications16
Ho"pital )re!erence3 $gle"ton>>>>>>> Scotti"h Rite>>>>>>>>> Hughe" Spalding>>>>>>>>>>>
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