Please enable JavaScript in your browser to complete this form.LayoutStudent's Name *Location Incident OccurredDateTime of IncidentLayoutType of IncidentIllnessInjuryBehaviorType of IllnessFeverEye DischargeRashCoughDiarrheaLiceVomitingOtherMay Return In24 Hours48 Hours72 HoursDoctors Note RequiredLayouttype of InjuryBiteBruise/BumpCut/ScapeSplinterAllergyChokingEye InjuryNose InjuryHead InjuryCause of InjuryFall/TripBumbed into ObjectAnotherRunningClimbingOther* If "Other", fill inFirst Aid GivenWash/CleanedIce PackBand AidParents NotifiedVerbalCalledMessagedCommentsLayoutParent's Name *Teacher's Name *Submit