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Little Oak Medical Form

Please fill out the form below so we can be aware of any allergies or medical needs.

Parent's Name*

Child's Name*

Allergies*

Please list any other medical needs you would like us to be aware of.

Emergency Contacts*

By checking this box, you consent to your child receiving emergency medical care and treatment during Little Oak program hours if needed.

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ADDRESS

PHONE

EMAIL

117 S Cook Street #118, Barrington, IL 60010

(224) 616-2724

info@oakleafcooperativeschools.org

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Oak Leaf Cooperative Schools does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. These activities include, but are not limited to, hiring and firing of staff, selection of students and volunteers, and provision of services. We are committed to providing an inclusive and welcoming environment for all members of our staff, students, and volunteers.

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