Berkeley County

Consent Forms:

  • To enroll in the program, please complete the consent forms below.
  • When asked, please enter parent/guardian first and last name.
  • If you don’t have an email address, please use:
  • If you have questions about the program, please contact your school nurse or e-mail

English Consent 

Spanish Consent 

Visits at Home:

To schedule a virtual visit when school is in session at participating schools, call 843-792-0355 between 8 a.m. to 4 p.m.

Participating Provider/s:

Learn More:

Click here to learn more! (PDF)

Clic aquí para saber más (PDF)

Participating Schools:

J K Gourdin Elementary School
1649 Highway 45
Pineville, SC 29468

St. Stephen Elementary School
1053 Russellville Road
St. Stephen, SC 29479

St. Stephen Middle School
225 Carolina Drive
St. Stephen, SC 29479