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Health Forms

Please read the description of each health form carefully as each is designed for specific physical assessment requirements or medication administration needs. It is important that all parent information is completed on all forms prior to submitting them to the school nurse. 

Mandated Physical Forms

Mandated school physical form to be completed within one year prior to the first day of school for entry into Kindergarten, Grade 7, and Grade 10. Mandated school sports physical and permission forms necessary to try out and participate in school sports grades 6 through 12.

Health Assessment Record Grades K-12 and Sports Physical Form("blue form")


Mandated school physical form to be completed within one year prior to the first day of school for entry into Preschool:


 

Medication Administration Forms

Contact the school nurse to discuss your child's medication needs during the school day.

The term "medication" refers to any category of prescription and nonprescription preparations.

  • No medication will be accepted in envelopes or bags. Do not send any type of pills, liquids, creams or lotions to school with your child.
  • A maximum three month supply can be brought to the school nurse by a parent, guardian, or responsible adult.
  • All medications must be picked up within one week following termination of order or on the last day of school by parent, guardian or responsible adult.

Authorization for Medication by School Personnel form for all medication administration EXCEPT the following:

  • Epinephrine auto-injector administration
  • MDI Self-Administration
  • Ibuprofen ages 12 and up
  • Aspirin substitute containing acetaminophen

Authorization of a Parent or Guardian for the Administration of Ibuprofen or Aspirin Substitute Containing Acetaminophen allows Ibuprofen to be administered to students 12 years of age and up and Aspirin Substitute Containing Acetaminophen to students of all ages.
These forms do not require a physician signature.

2024-2025 Form for Authorization by Parent/Guardian for the Administration of Ibuprofen or Acetaminophen


Epinephrine Auto-injector Self-Administration form for students who are able to self carry and self administer Epinephrine with MD, parent/guardian authorization and School Nurse review:


Metered Dose Inhaler (MDI) Self-Administration form for students who are able to self carry and self administer their prescribed inhaler MDI) medication with MD, parent/guardian, and school nurse authorization:


Sunscreen forms should be filled out by the parent/guardian for any student age 6 and older who is capable of self-applying their own sunscreen. If a student needs assistance with sunscreen application, an Authorization for Medication by School Personnel form (above) must be completed and signed by a physician.

Please note: Spray-on Sunscreens are not permitted

2024-2025 Form for Authorization by Parent/Guardian for Sunscreen 


Expiring Forms from the 2023-2024 School Year: These forms will not be accepted after August 1, 2024.

Authorization for Medication by School Personnel
Inhaler (MDI) Form
Epinephrine Auto-injector/Benadryl Administration Form
Form for Authorization by Parent/Guardian for the Administration of Ibuprofen or Acetaminophen


Diabetes Management Plan

The Diabetes Management Plan and School Treatment Authorization form is to be completed annually for any student with diabetes at the opening of the school year.

Diabetes Management Plan and School Treatment Authorization

Please contact your school nurse if you have any questions regarding the appropriate form for your child's medication needs.

All students requiring medication in school will have a Medication Administration Plan implemented by the School Nurse.