If you have already registered a student in the Program for the summer of 2021, please send in the following health and consent forms for the Newton Health Department and the Commonwealth, to complete the registration process. These forms are necessary for our annual review with the City Health Department and required for your student's participation in the program.
You can download these forms as PDF files and print them out (links open in new window):
ESP Immunization Record (Staff & Students under 18) + Special Activities Permission Form (3 pages)
Authorization to administer medication to a camper form + signature page (1 page)
Mail the completed forms (total of six pages) and a doctor's exam sheet (dated within past 2 years) to:
David Backer, Executive Director
Environmental Science Program
P.O. Box 600292
Newton, MA 02460
Questions? Please call 617-447-9317 or email email@example.com
Thank you for registering for the Environmental Science Program!
ALL families: Please Note about this Authorization form:
The Department of Health expects the Program to have the "Authorization to administer medication" form in our records for ALL students when our records are reviewed. Please download and complete this form, and include it with your other forms, even if you just write "Taking no medications". This will help to make our review with the Department of Health successful.
If you omit this form, we will just need to ask you for it. Thank you.