Important: Your admission to Brewster Academy is not official until all of the records listed below are received by the Health Center. The following forms were mailed to all new and returning parents in early May. They also are available here as PDF documents. Please download the forms and take time together with your student to review the forms and accurately complete them. Sign the forms and mail by July 1 to the Brewster Academy Health Center (80 Academy Drive, Wolfeboro, NH 03894). The phone number at the Health Center is 603-569-7121. Forms cannot be submitted online.

Medical Authorization: Please make sure information is legible. We must have a copy of the front and back of the health insurance card with the policyholder’s name and date of birth (does not apply to international students). If dental coverage is available, please send a copy of the dental health card (to be used for dental emergencies only). Parent and student need to sign form.
Medical History: This is to be completed by a parent. Parent and student need to sign.
Health Center Policy: Please read carefully and review with student. The policy outlines responsibilities of parents, students and nurses. Parent and student need to sign.
Immunization Record: Required for new students only. All required immunizations must be completed prior to student’s arrival at Brewster Academy.
Medication Contract: This form is required even if your student does not take medication. If your child does take prescription medication, it is imperative that you review this together as there are consequences for missing meds. Parent and student need to sign form.

Medication Information: To be completed by the student’s physician if the student is on any medication.
Physical Exam for New Students or Physical Exam for Returning Students: A yearly physical examination is required. Please call early to schedule their appointment. Occasionally, an exam is not able to be completed by July 1st. If this occurs, please return all the other forms and attach a note indicating the date of the physical exam. Please forward exam report when completed.
Flu Vaccine Permission Form: Please sign and send this form in if you would like for us to administer the flu shot to your child. This is the only form you will receive for the flu vaccine.
International Student Accident and Health Insurance Form. Health Insurance for international students is available through ISM (Independent School Management). This insurance is mandatory unless parents of international students carry health insurance that provides coverage for students while in the United States and has a U.S. mailing address.
Patient Rights and Responsibilities: This is not a form but rather a review of patient rights and responsibilities that is mandated by New Hampshire state law. It is expected that parents and students will review the form together. It does not have to be signed or returned.

If your child is taking any prescription medication, we request that you mail it directly to the Health Center prior to your student’s arrival in September. If this is not possible, you can bring the bottled medications directly to the Health Center when you bring your student to school. No medications will be accepted at the Health Services registration table in the Smith Center. Please do not give any medications to your student to bring to the Health Center.

Please contact the Health Center with any questions or concerns you may have so we can work together to support your child’s health needs.

Brewster Academy Health Center

Cynthia Patterson RN BN, Director of Student Health Services

603-569-7121