Luther Lurhank

.K

n

Health Services
Dear Parent

The Luther Burbank School District, in collaboration with the Children's

Health Initiative and Supervisor James Beall, is launching an innovative
effort to help every uninsured student obtain health benefits by enrolling
in a health insurance program. We believe that a healthy child is more
likely to come to school ready to learn and to succeed academically. Now,
more children qualify for free or low-cost medical, dental and vision care

coverage programs!
Does your child have health insurance?
1. YES

2.

Please identify with a check mark what type of health insurance your child presently has.

□ Healthy Kids

□ Healthy Families

□ Medi-Cal

□ Blue Shield

□ Kaiser Permanente

□ Health Net

□ Blue Cross

□ Aetna

□ Other

If you said NO, do you want us to help you get health insurance for your child? Please
complete the following information, and a representative will contact you.

NO

Parent/Guardian’s Name:
Child’s Name:

Your Area Code and Phone Number:(.
Alternate phone number £

Best Time to Call:

1

It is very important that you complete this form today and that your child
returns it to their teacher! Please submit to your teacher by Sept 6, 2002.
Should you have any questions, please feel free to contact our school at (408)
295-1813.

Teacher:
Grade:

School Name:
Room #

Thank you for joining us to ensure that our children have a healthy and bright future
Every classroom whose students return all of the health surveys (1007o completed)
will be awarded a pizza party for their entire classroom!