Medical Information & Forms

Holland Christian Schools is delighted to utilize the school nursing services provided by the Holland Hospital School Nurse Program for our students at all HC schools. HC’s school nurse, Hendrina Cupery, is employed by Holland Hospital and contracted for school health services at Holland Christian Schools.

The school nurse at Holland Christian maintains school care plans for those with chronic diseases (such as asthma, allergies, diabetes, and seizures); provides health education in classrooms as needed; provides illness and injury assessment and interventions; participates in students’ Individualized Education Plans (IEPs); and develops, trains and supervises staff for first aid and medication administration. For more information about the program visit the Holland Hospital website.

Hendrina Cupery, RN
Manager of the Holland Hospital School Nurse program
616.394.3414
cupery@hollandhospital.org

Medical Forms

Medications may be administered at school by school personnel when necessary for school attendance. This completed form along with the medication and/or special equipment items are to be brought to the school by the parent/guardian.

The following information is requested so that the school can work with you, the parent, to meet the physical, intellectual and emotional needs of your child.

The following information exists to help protect your children from concussion or other serious brain injury. Use this info to learn how to spot a concussion and what to do if one occurs. Parent/guardian & student signatures are required.

Please complete this Migraine Individualized Health Plan to give your consent for the school to administer medication or procedures.

Please complete this Seizure Individualized Health Plan to give your consent for the school to administer medication or procedures.

Please complete this Asthma Individualized Health Plan, or submit a current plan already on file in your child’s physician’s office.

Please complete this Allergy & Anaphylaxis Emergency Plan to give your parental consent for the school to administer life-saving medication or procedures.

Please complete this Life Threatening Allergy Individualized Health Plan, or submit a current plan already on file in your child’s physicians’s office.

Have Questions?

We are here to help! Contact our school nurse  at 616.394.3414 or cupery@hollandhospital.org with any questions.

Email cupery@hollandhospital.org