Health Services
State of CT Health Exam Form Medication Form Sports Physical Form
  Allergy Form  

Welcome to the Notre Dame Health Department.

Notre Dame is staffed from 7:45 a.m. to 2:15 p.m. by a registered nurse, provided by the Fairfield Health Department/Public Health Nurses. The purpose of the Health Department is to promote a healthy environment for the Notre Dame community. The website offers the needed forms for download. If there is a specific health concern for your child, please consult the nurse as soon as possible so that a care plan may be formulated, and if needed, guidance and faculty notified of any pertinent information.

State of CT Health Exam

In accordance with the Connecticut General Statutes, each student
entering Notre Dame must have a current health assessment submitted to the school nurse. This assessment must be done by a legally qualified practitioner of medicine, an advanced practice registered nurse, a registered nurse, or a physician's assistant.

Download State of CT Health Exam Form (.pdf)

Medication Form

Some students require medications during the school day for either a long-term or a short-term period. These medications may be ordered on a daily basis or "when necessary." At Notre Dame, medications may be administered in one of two ways:

Medications Administered by the Nurse
This requires the completion of a form by parent and authorized prescriber (physician, physician's assistant or APRN), and the delivery of the medication to the Nurse's Office by the parent. The medication will then be administered by the Nurse to your child according to the prescriber's order. The medication must be in an appropriately labeled container as described in the form.

Self-Administered Medication

This requires the completion of a form by both parent and authorized prescriber, specifically circling the part indicating the student's ability to self-administer the medication and must be deemed safe and appropriate by the School Nurse. The form is kept on file in the Nurse's Office and the student may carry the medication with him/her, in a correctly labeled container as described in the form below, and self-administer the medication.

I strongly encourage self administration as this prepares your child to care for him/her self throughout life.

Download Medication Form (.pdf)

Severe Allergy Form

If your child has a severe allergy that requires use of an EpiPen in school please have your MD complete this order form. Be sure that a plan of action is ordered should your child require an EpiPen injection during the school day. If your child will self carry and self administer his/her EpiPen, please be sure that your doctor completes  the "Student may self-administer medications" portion at the bottom of the form. If a child self carries their EpiPen it is that child's responsibility to have it in their possession daily and check to be sure it is not expired.

Download Severe Allergy Form

Sports Physicals

To participate in interscholastic sports at the Varsity, JV, or Freshman level, students are required to have a physical exam, conducted by their health care provider (physician, physician's assistant, APRN or RN), on record in the Nurse's Office.

This exam must have been done within one (1) calendar year of the end of the particular sport in which the student plans to participate and is good for 13 months (for example: a physical done on 8/15/11 is good until 9/15/12).

This physical must be on record PRIOR to try-outs; there are no exceptions. Physicals must be submitted to the School Nurse, not to your coaches.

If a student's exam expires in the middle of the particular season, he or she may begin the season but must have an updated physical by the expiration date.

Download Sports Physical Form (.pdf)

Notre Dame High School | 220 Jefferson Street | Fairfield, Connecticut 06825 | 203.372.6521