School-Based Health Parental Consent Forms
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School-Based Health Parental Consent Forms

To register your child for school-based health center services, you will need to sign and return an enrollment packet. Please find your child’s school from the list below, click the link for the school’s enrollment packet, read the information and fill out the forms (Parental Consent Form and Basic Health History).

To return the completed forms, you can:

  • Fill out the forms electronically, and email them to the secure email address listed for your child’s school-based health center. (Please note: the email addresses below are for submitting forms only. If you have any medical or urgent questions, please call your child’s school-based health center directly.)
  • Print and fill out the forms, and give them to a parent coordinator
  • Print and fill out the forms, and return them directly to the health center

If you need assistance emailing the forms, please call your child’s school-based health center directly.

Scroll below to find the forms for your child’s school-based health center:

 

James M Kieran Campus School-Based Health Center

This health center serves students at:

  • J.H.S. 123 – The Bronx Urban Community Magnet School
  • M.S. 337 – The School for Inquiry and Social Justice

Click here for forms

Email forms to: JamesKieranSBHC@institute.org


Murry Bergtraum School-Based Health Center

This health center serves students at:

  • Murry Bergtraum High School for Business Careers
  • Manhattan Early College School for Advertising (MECA)
  • Urban Assembly Maker Academy
  • The Urban Assembly School for Emergency Management

Click here for forms

To email your completed forms, send to MurrySBHC@institute.org


Harlem Children’s Zone Promise Academy I School-Based Health Center

Click here for forms

To email your completed forms, send to PromiseAcademy1@institute.org


Harlem Children’s Zone Promise Academy II School-Based Health Center

Click here for forms

To email your completed forms, send to PromiseAcademy2@institute.org


P.S. 57 James Weldon Johnson School-Based Health Center

Click here for forms

To email your completed forms, send to PS57SBHC@institute.org


High School of Fashion Industries School-Based Health Center

Click here for forms

To email your completed forms, send to FashionSBHC@institute.org


Washington Irving Campus School-Based Health Center

This health center serves students at:

  • Gramercy Arts High School (GAHS)
  • The High School for Language and Diplomacy (LAD)
  • The International High School at Union Square (IHS)
  • The Union Square Academy for Health Sciences (USA)
  • The Academy for Software Engineering (AFSE)

Click here for forms

To email your completed forms, send to IrvingSBHC@institute.org