FORMS
Medication Forms
Medication Guidelines Please remember that each medication must have a new physician’s order each school year, and must be brought into the health room by the parent, guardian, or another designated adult (not the student) in the original container.
Inhaler Forms
Request for Permission to Administer an Inhaler
Asthma Inhaler Self-Administration by Students For students in 3rd grade and higher only.
Epi-Pen Forms
Request for Permission for Administration of an Epi-Pen
Request for Permission for Self-administration. For students in 4th grade and higher only. Both this form and the "request for permission for the administration of an epi-pen" must be filled out and returned to the nurse.
School Physicals
A physical exam is required for all students in grades K/1, 6, and 11. Print out this form, and give it to the physician to fill out on the day of your student's exam. Please note, a sports physical and/or a physical for a driver's license/permit is acceptable for the 11th-grade physical; turn in a copy to the school nurse.
School Dentals
A dental exam is required for all students in grades K/1, 3, and 7. Print out this form, and give it to the dentist to fill out on the day of your student's exam, and return it to theschool nurse.
Field Trip Permission
Special Dietary Needs
(Gold Form)
If your student has any food allergies or other special dietary needs, please print out the forms to the right. The "SN 6 food allergy information" should be filled out by the parents and returned to the school nurse. The "dietary gold form" must be filled out by your student's physician and returned to the school nurse. Please note that if there are any changes and the student is no longer allergic to the food stated on a previously completed form, a new form with physicians signature stating that the student is no longer allergic is required.
SN 6 Food Allergy Information
Dietary Gold Form.pdf