School Health Documents

Listed are various required health forms.  Each form is available to view or print by clicking on the specific form name.  Downloading Adobe Acrobat may be needed to read and print pdf files.

EMERGENCY MEDICAL/ ACTIVITY PARTICIPATION PERMIT  Should an emergency occur and medical attention needed during school hours or activity, this form provides written permission to treat your child and a means of contacting the parent/guardians.  It also provides written consent for your child to participate and attend field trips, games and other school-related activities.  This form must be signed each school year at enrollment.

HEALTH HISTORY  This form provides the school nurse with pertinent information on allergies, medications, on-going illnesses or injuries, or situations that can affect the student’s daily school activities and learning process.  This form is completed yearly by the parent/guardian.  All information is confidential and will be shared with educational staff on a “need –to-know” basis only.

IMMUNIZATIONS  Immunizations are recommended for optimal health and are required by the State of Kansas in order to attend public schools. 
A complete list of recommended immunizations can be found at the following website http://www.kdheks.gov/immunize/index.html Click on School Info, then
New School Immunization Requirements for 2008.    Those with Medical or Religious exemptions can find forms at this site, from their physicians, or from the School Nurse and need to be completed on a yearly basis.

PHYSICAL EXAM FORMS:  Kansas law requires a physical examination of all kindergarteners and any new student entering the district, regardless of age.  Students in grades 5-9 and those participating in Middle School and High School Sports are required to have a physical examination prior to school beginning or sports practices.
A School Form is available for K-4th grade.  A PPE form is available for 5-12th grades and requires the signature of the physician, parents/guardian and the student.
(PPE is the Pre-Participation Physical Evaluation form provided by the Kansas State High School Activities Association.)

REQUEST for ADMINISTRATION OF MEDICATION  The school is able to administer prescribed medication and over-the-counter medications during school hours and field trips ONLY with a written prescription from a physcian and signed consent from parents/guardians.  Board policy does not allow for any type of medication to be kept on hand for students for an “as needed” use, this includes over-the-counter medications.  Any and all medications given to a student must have this form signed by both the physician and the parent/guardian.  The prescribed medication must be brought to school in its original container, labeled with the child’s name, name of medication and clear directions for use.  This includes temporary medications (antibiotics, etc.) over-the-counter meds (Tylenol, Ibuprofen, etc.) as well as any on-going, daily medications.
All medications will be kept locked in the school’s main office and dispensed from there by the school nurse or designated staff.  The exceptions are those with “Self Medication” permission, such as inhalers, etc.  Forms and medication are to be brought to the office by parents, especially if the student is riding the bus.  Parents should pick up any unused medications at the end of the school year.  Any left over medications will be destroyed.  A new consent form must be completed each school year.

SELF MEDICATION PERMISSION  This form is similar to the Medication Permission form, but allows the student to carry and administer the medication themselves. Students should be knowledgeable of their health condition/disease and demonstrate correctly the use of their medication. Permission is limited to Inhalers, Insulin and Epi-pens.  This does not include over-the-counter medications such as Tylenol or Ibuprofen or controlled substances of any kind such as Ritalin, Adderall, Concerta, etc.  It is preferred to have back-up medications on hand at the school’s office in case of emergency.  A Request for Administration of Medication form is not necessary, but helpful.  These forms need to be completed each school year.