WebIn order to provide the best educational experience, school personnel must understand your child’ s health needs. This form requests information from you (Part I) which will also be … WebOR EMPLOYMENT CT-HR-12 NEW 10/20/2010 (formerly Form PLD-1) Last Name First Name MI STATE OF CONNECTICUT Application for Examination or Employment (CT-HR-12) DO NOT WRITE in shaded area APPROVED DISAPPROVED REVIEWED BY: AE …

Athletics Physical Form - Connecticut Technical Education and …

http://www.egfpct.com/Portals/0/Files/Forms/State%20of%20CT%20HAR%20School%20Form.pdf WebCT-6 (10/14) Legal name of corporation DBA or trade name(if any) Mailing name (if different from legal name) c/o Number and street or PO box City State ZIP code Mailing address Certification: I certify that this election and any attachments are to the best of my knowledge and belief true, correct, and complete. Authorized person Paid preparer ... flags windows 10

Form Har 3 ≡ Fill Out Printable PDF Forms Online

WebHAR-3 REV. 4/2010 To be maintained in the student’s ... If your child does not have health insurance, call 1-877-CT-HUSKY Address (Street, Town and ZIP code) Parent/Guardian Name (Last, First, Middle) Home Phone Cell Phone ... All medications taken in school require a separate Medication Authorization Form signed by a health care provider and ... WebHAR-3 REV. 4/2010 Signature of health care provider Date Signed Printed/Stamped Provider Name and Phone Number Physical Exam Student Name Birth Date Date of Exam °ÊI have reviewed the health history information provided in Part I of this form Note: *Mandated Screening/Test to be completed by provider under Connecticut State Law http://www.egfpct.com/Portals/0/Files/Forms/State%20of%20CT%20HAR%20School%20Form.pdf canon printer always shows offline