GUMC PRESCHOOL
REQUIRED STUDENT FORMS
Keeping children safe-Keeping staff informed
Required Forms:
1.Registration Form
2. Emergency Form
3. Health Inventory
4. Lead Blood Test Certificate
5. Immunization Certificate
6. Know Our Family Intake Form
7. Permission to Drop Off/Release of Child Form
8. Allergy Action Plan*
9.Medication Administration Form*
10. Asthma medication Administration Form*
* read below for details
REQUIRED STUDENT FORMS
Keeping children safe-Keeping staff informed
Required Forms:
1.Registration Form
2. Emergency Form
3. Health Inventory
4. Lead Blood Test Certificate
5. Immunization Certificate
6. Know Our Family Intake Form
7. Permission to Drop Off/Release of Child Form
8. Allergy Action Plan*
9.Medication Administration Form*
10. Asthma medication Administration Form*
* read below for details
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Registration Form
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A completed Registration Form is required to enroll your child in classes at GUMC. A new Registration Form must be completed for each year the child returns to GUMC. Use the link to download, print. and return this form with your registration fee and deposit. Class Options with tuitions are listed on page 2 of this document.
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Emergency Form
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The Emergency Form is required to be on file for every student at the attending school. This form gives the staff a point of contact if you cannot be reached in the event of emergency, and gives the staff permission to seek emergency care in the event of an accident. If it becomes necessary to transport your child to the hospital, this form would accompany. Download and print using the link. Complete thoroughly, paying specific attention to required signatures.
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Health Inventory
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All children attending GUMC for the first time must submit a completed Health Inventory Form (Part I by parents/Part II by doctor) with exam having been administered no more than 12 months prior to the date of enrollment. For returning students, new forms need only be resubmitted when the child has a new physical exam. Please have health care provider sign where directed. NO STUDENT WILL BE ALLOWED TO PARTICIPATE IN SCHOOL ACTIVITIES UNTIL THIS FORM HAS BEEN SUBMITTED. Use the link provided to download , print and take to your health care provider.
| occ1215-healthinventory.pdf |
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Lead Blood Test Certificate
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A MDHMH Blood Lead Test Certificate is required to be on file for all children born on or after January 1, 2015, regardless of place of residence. Using the link below, print the Lead Blood Certificate and take to your health care provider. Please be sure signatures are applied where requested. Return to GUMC office with child's other paperwork.
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| marylanddhmhbloodleadtestingcertificate.pdf |
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Immunization Certificate
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A current MDH Immunization Certificate is required to be on file for all students attending classes for the first time. Updated Immunization Certificates should be submitted as new immunizations are administered. NO STUDENT WILL BE ALLOWED TO PARTICIPATE IN ANY SCHOOL ACTIVITIES UNTIL THIS COMPLETED FORM HAS BEEN SUBMITTED. Please use the link provided to download, print, take to your health care provider, and return to school.
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| maryland_immunization_certification_form_dhmh_896_-_february_2014.pdf |
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Know our Family Intake Form
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The "Know Our Family Intake Form" is required from each student prior to beginning their first class at GUMC ,and EACH YEAR the child returns to GUMC. Teachers use this form to better understand your child's progress and family structure. Download and print using the link provided. Complete and return with your child's other paperwork.
| know_our_family_intake_form.pdf |
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Permission to Drop/Release of Child Form
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The Permission To Drop off/ Release of Child Form is required from all students at registration, and a new form must be submitted EACH YEAR the child returns to GUMC. This form allows parents to authorize family members/friends to drop off/pick up their child from school. CHILDREN WILL NOT BE RELEASED TO ANY PERSON IF THEIR NAME IS NOT ENTERED ON THIS FORM. Names can be added by request in the school office. Identification may be required for those picking up for the first time. Use the link provided to download, print, and return this completed form with your child's other paperwork.
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| GUMC Release of Child Permssion Form |
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Allergy Action Plan
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An Allergy Action Plan must be downloaded, printed , and taken to your health care provider if your child has stated allergies at registration. This form must be resubmitted each year your child returns to GUMC. Upon the onset of symptoms , staff will follow this action plan for treatment of your child.
Should rescue medications be prescribed for your child, a Medication Administration Form (below) must be completed. Return completed forms to the school office where a care plan will be discussed. 
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| Allergy Form |
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Medication Administration Form
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A Medication Administration Authorization Form is required to be completed by your health care provider for any medications to be given while your child is at school. Medications, with completed forms, should be presented to the school office where a care plan for your child will be discussed. Medications must be in their original containers with the child's name clearly present. Prescription medications must have the pharmacy prescription label on the outside of the package. A separate Medication Administration Form is needed for each medication administered.
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| Medicine Administration Form |
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Asthma Medication Administration Authorization Form.
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If your child has asthma, an Asthma Medication Administration Form must be on file in the school office. Download using link below, print, and take to your health care provider. This completed form and any required medication must be presented to the school office where a care plan for your child will be discussed.
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| asthmaactionform_jun14_1_.pdf |
Contact Us : GUMC Preschool 13900 Burntwoods Road Glenelg, MD 21737
410-489-7702 admin@gumcpreschool.org
Hours of Operation Monday - Friday 9:15-2:15