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IEA Medical History and Release

Red Asterisks (*) indicate a field that is required for the application to be submitted.



Confidentiality of Student Communication

Dear Parents and Students,

 

The Institute for Educational Advancement’s policy regarding confidentiality of communication states that all discussion in formal staff-student sessions is confidential. Information that is directly shared or gleaned related to potential serious health and safety concerns of the child or potential harm to others is discussed with IEA administration immediately. Parents are instantly informed and provided with pertinent information, referrals, and advice as requested. 

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Medical History

Parents/students must complete all required Medical History forms before the course start date to participate in Academy.



















Medication Needs

Please send all medications (OTC and prescription) in their original containers/packaging, clearly marked with your child’s name. Please enclose all medications in a Ziploc bag. All medications will be kept and handled by the camp medical staff for the duration of the camp session. Unidentified medication will not be dispensed. No medications will be permitted in the cabins (other than asthma inhalers).

Scheduled Medications






















As-Needed Medications


Medication such as inhalers, Benadryl, Tylenol, etc.












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While we prioritize safety measures at Academy and do not anticipate any medical emergencies, obtaining the following insurance information enables IEA staff to transport your child to a nearby healthcare facility for prompt and suitable medical treatment in the event of an emergency.

Health Insurance Information










Document Attachment
File Attachment: 
  • Media files must be attached as a .doc, docx, png, pdf or jpeg file. 
  • File size cannot exceed 25mb. 
Please note: Students must have health insurance to attend class. Please attach a copy of your child’s medical insurance card (front and back).


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Emergency Contact Information

Although we do not anticipate an emergency occurring at Academy, providing IEA with the information below will ensure your child receives the best possible care should something arise.

 

In the case of illness or emergency, IEA will contact the persons below in the order they are listed. By noting them below, you are giving these individuals permission to authorize treatment for your child and/or for Academy to release your child to them in the case of an emergency.  Please note, at least one contact must be a parent/legal guardian, and one contact must be someone other than a parent. 

Primary Emergency Contact










Secondary Emergency Contact










Tertiary
 Emergency Contact










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Emergency Consent Release

I am the parent/guardian of the above-named minor. In case I am unable to be reached during any emergency, I hereby authorize a representative of the Institute for Educational Advancement, pursuant to the provisions of California Family Code section 6910, to act as my agent to consent to the giving of all medical, dental, hospital, or surgical care to the above-named minor. I understand that I am fully responsible for the cost of any medical care rendered to my child. The undersigned declares under penalty of perjury that he/she is the parent or legal guardian of the above-named minor and grants the above authorization.

 

If there is a religious objection to consenting to the receipt of emergency medical or surgical treatment, the authorized person shall submit a written statement to the effect that the student is in good health and that the person signing assumes the health responsibility for the student.



Liability Release

assume full responsibility for all risk of injury or loss which may result from participation in any current and future classes at the Academy and agree to hold harmless, release and forever discharge IEA, its contributors and their respective officers, directors, agents and employees. I agree to waive any and all claims and demands whatsoever which I, my child or any third party may now or hereafter have against any IEA party by reason of accident, illness, injury or death to persons, or damage to, or loss of any property, arising or resulting directly or indirectly from my child’s participation in this Program. I understand that I am responsible for the cost of repairing or replacing any property that my child damages during Academy.  



Health and Wellness Policy

When to Stay Home from Academy 

Students with mild Covid-like symptoms should take a test (PCR or rapid), and only attend if the test is negative, they do not have a known Covid exposure, and symptoms are improving. Students with moderate to severe Covid-like symptoms must stay home. 

 

If your child is ill with a contagious or communicable illness, please keep them home. Students should not attend Academy if: 

    • they have a fever of 100.4 F or higher (following an illness, temperature should remain normal for 24 hours before they return to Academy) 
    • they have vomited or had diarrhea within the previous 24 hours 
    • they have a sore throat or upset stomach 
    • they are coughing excessively, or their chest and nose are severely congested 
    • there are any signs of contagious infection such as pink eye, etc.
If you have questions about your specific situation, please call an Academy Team member at 626-403-8900 or email academy@educationaladvancement.org. 

 

Contagion Mitigation

We ask all members of our community to adhere to the following:

    • Individuals with mild and improving symptoms of any kind are encouraged to wear a mask in class to reduce the spread of illness.  
    • Individuals who have been in close contact with someone with COVID-19 are expected to follow current CDC guidelines for masking and testing. 
    • If a student develops any of the symptoms described above while onsite for classes, we will call you to pick them up. 
    • We encourage individuals to wash their hands frequently and to properly cover their sneezes and coughs. Support from parents on reinforcing these behaviors at home is appreciated! 

In addition, we clean all high-touch surfaces frequently and have HEPA air filters running anytime classes are in session.