School Health Screening Consent

School Health Screening Consent — Form Fields

This healthcare template includes 10 fields. Obtain parental consent for student health screenings including vision, hearing, and scoliosis checks. Free to customize and use on ZenBuild.

• Parent or Guardian Full Name (text, required)
• Parent Email (email, required)
• Student Full Name (text, required)
• Student Date of Birth (text, required)
• School Name (text, required)
• Grade (text, required)
• Screenings You Consent To (checkboxes, required) — options: Vision screening, Hearing screening, Height and weight (BMI), Scoliosis check, Blood pressure, Dental screening
• Does Your Child Have Any Conditions We Should Be Aware Of? (multiple choice, required) — options: Yes, No
• Please Describe Any Relevant Conditions (long text, optional)
• Parent Signature (Type Full Name) (text, required)