Health Forms

Forms can be accessed at the bottom of the page or click on title of form needed

• Universal Health Form

A completed and signed physical exam form MUST be submitted upon entering kindergarten or upon transferring into the school district (other grades) within 30 days of entering school. 

• Epinephrine Administration Form

Epinephrine Administration Forms must be submitted each year for students with anaphylactic allergies.  The form must be submitted to the school nurse prior to the start of each school year.  Parents must provide epinephrine auto injectors to the school to be administered in the event of a reaction while in school or on out of school field trips/activities.

• Asthma Action Form 

Asthma Treatment Plan must be submitted each year for all students with asthma that require medication either daily or on an as needed basis.  This plan and inhalers must be submitted to the school nurse prior to the start of each school year.

• Medication Administration Form Prescription / Over-the Counter: This form authorizes the school nurse to administer medication to a student on a daily basis (such as medicine for ADHD or diabetes) or on an "as needed" basis for minor ailments (such as Advil or Tylenol for headaches or minor pains, or allergy medication such as Claritan or Allegra) if needed at school. This form must be filled out by a health care provider and signed by a parent/guardian for EACH medication to be given at school. Different forms are required for asthma medication or epinephrine.