Dear Parents,
              We are looking forward to a wonderful new school year at Yeshivat He’Atid. The health and well being of each and every child is of the up most importance to us. To help us insure the health of your child it is imperative that each child have up-to date health records on file at school. All forms are due back by August 10th. Please scan and email back or mail to 1500 Queen Anne Road, Teaneck NJ 07666 AFTER July 25th. No child will be allowed into school on the first day without the required forms. PLEASE DO NOT SUBMIT CAMP FORMS. All students must meet the state requirements for their age/grade, or they will not be allowed to remain in school. We do not accept religious exemptions for vaccinations.

Required Forms:

This form is to be completed in full for each child annually and signed by a parent or legal guardian.

Health History and Emergency Authorization Form 2017-18


This form is to be completed by the child’s pediatrician. Yeshivat He’Atid requires an annual physical exam for every child. This form includes the immunization record. All students must meet the state requirements for their age or they will be excluded from school until they are up-to date.
Annual flu shots are required for all Pre-K students and must be received before December 31st:

Physician's Form

Elective Forms:

This form needs to be signed by both a parent AND needs a doctor’s signature.  No medication will be given without this form completed in full:

Acetaminophen/ Ibuprofen Authorization Form 2017-18


If your child has any allergies that require Benadryl, epinephrine or other allergy medication you and your doctor must complete this form. There needs to be BOTH a parent and a doctor’s signature:

Food Allergy Action Plan 2017-18


If your child has chronic or even occasional asthma, please complete the form WITH your doctor.  There must be BOTH a parent and a doctor’s signature:

Asthma Treatment Plan 2017-18


If your child is to receive ANY MEDICATION in school prescription or over the counter this form must be completed with a DOCTOR’S ORDER and signature. The medication must be sent to school in the original pharmacy bottle. Additionally, since your child spends a large portion of his/her day in school, it is very important to notify me if your child is taking ANY medication daily at home. Children are not allowed to self-administer any medication, whether prescription or over-the-counter in school:

Medication Administration Form 2017-18

If you have any specific concerns, be they physical or emotional, regarding your child please do not hesitate to contact me. All issues will be kept strictly confidential and will only be shared with the appropriate staff if necessary and if permission is given.

I am looking forward to a happy, healthy and rewarding year ahead with your child. Thank you in advance for completing these forms in a timely manner. I can be reached over the summer via email at

Rachel Aron RN
School Nurse