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Nurses (Mrs. Dietz and Mrs. Kirkwood) Web Page » Health Forms

Health Forms

Nurses Forms

Your child's health is very important to us. Providing medical information about your child assists us in responding appropriately to support student health and health maintenance. Please download the necessary forms from the list below, complete as required, and return to your child's school nurse at your earliest convenience.

Allergy Action Plans - Food and Non-Food - and Waivers of Liability

This form provides important allergy information to school medical personnel so that an appropriate individualized health care plan is in place during the time the affected student is in the school environment.

Asthma Treatment Plan
This form provides important asthma treatment information to school medical personnel so that an appropriate individualized health care plan is in place during the time the affected student is in the school environment.

Diabetes Management Plan
This form provides important diabetes management information to school medical personnel so that an appropriate individualized health care plan is in place during the time the affected student is in the school environment.

Health Immunization Requirements for Sixth Graders/11-Year-Olds
The NJ Department of Health and Senior Services requires parents/guardians to provide updated immunizations records for their child prior to the child entering sixth grade or reaching 11 years of age.

Permission to Administer Medication During School
This form grants permission to the appropriate school personnel to administer medication to a student during school hours.

Permission for Self-Administration of Epi-Pen and/or Inhaler and Waiver of Liability
This form allows parents/guardians to grant permission for their child to self-administer an epi-pen or inhaler during the school day.

Permission for Designee to Administer Epi-Pen and Waiver of Liability
This form allows parents/guardians to grant permission for a designee to administer an epi-pen to their child during the school day.

Routine Physical for Fourth and Seventh Graders
Although not required, the district recommends that a child have a physical exam in fourth and seventh grades.

Sudden Cardiac Death Brochure
This brochure, published by the American Heart Association, contains important information about sudden cardiac death in young athletes.

FOR MIDDLE SCHOOL STUDENTS ONLY

 

Click here to access sports physical forms and information on Sports Information page or use links below.