Important forms

Medication at school forms

If your child needs to take a prescribed medication during school hours, the school must have a physician signed permission form with written orders from the child's physician and parent. 

Prescription medication form Click here

If your child needs to keep an over the counter medication during school hours, the school must have a parent signed permission form on file.  

Over the counter medication form Click here 

Student action plans/Individual health forms

Dover Eyota schools are committed to providing safe, individualized care to students with special health considerations. Communication with the school nurse is essential in ensuring that your child's health needs are managed appropriately in the school setting.

The development and implementation of your student's health plan allows for proper nursing interventions, and for the sharing of necessary information regarding your child's safety while at school. 

All student health plans need to be renewed annually at the beginning of each school year and as needed in response to any change in student health status.

Severe food allergies

The school will need an emergency action plan completed annually by the student's physician/allergist and updated as any changes are made.  This is different than the food allergy/intolerance special diet form.  We need both!

Submit the food allergy/intolerance special diet form to the dietary department (listed under the food services tab or listed below).

Food allergy/intolerance special diet form

Asthma

The school will need an emergency action plan completed annually by the student's physician/allergist and updated as any changes are made.

Seizures

The school will need an emergency action plan completed annually by the student's physician/allergist and updated as any changes are made.

Diabetes

The school will need an emergency action plan completed annually by the student's physician and updated as any changes are made.

Dietary intolerances

According to the National School Lunch Program Act, we are required to adhere to specific Federal regulations in accommodating students with a disability if the disability prevents the child from eating the regular school meal, the school will make modifications or substitutes prescribed by a licensed physician.  If you have questions or concerns regarding your student's dietary needs, please contact Amy Renken, Food and Nutrition Director at 507-585-8242.

Submit the food allergy/intolerance special diet form to the dietary department (listed under the food services tab or listed below).

Food allergy/intolerance special diet form 

Contact Amy Renken for lactose free milk forms if needed.

Physician forms are needed for any students requiring a wheelchair, crutches, walking casts, or other orthopedic devices. 

Medical equipment physician form