Health Services Forms

Health History/Emergency Form

Please complete this form upon enrollment or if there are changes to medical information or emergency contacts.

Medication Administration Form

Please read the "Medication Administration Policy" section of this form before completing and returning with medication. A doctor's signature is not required for over the counter medications.  All prescription medications must have doctor's authorization. 

Seizure Action Plan

If your child has been diagnosed with any form of seizure disorder, please have his/her physician complete this form and return it to the school nurse.

Asthma Action Plan

If your child has been diagnosed with asthma or other airway diseases, please have his/her physician complete this form and return it to the school nurse.

Food and Environmental Allergy Form

If your child is allergic to any foods or environmental allergens please complete the following form. 

Anaphylaxis Action Plan

If your child has been prescribed epinephren to treat allergic reactions, please have his/her physician complete this form and return it to the nurse with proper medication. 

Generic Action Plan

If your child has any health condition not already listed above, please have his/her physician complete this form and return it to the school nurse.