Forms

If your child requires medication to be administered at school, please complete the Medication Administration form below and present the form in person with the medication to your child’s front office.
 
Students who experience asthma, seizures, and/or severe allergies and who use emergency medications to treat those conditions should have an Emergency Care Plan (ECP) on file at school. Please complete the appropriate ECP form below and present the form in person with the emergency medication to your child’s front office. 

Please contact your school’s Secretary or the District Nurse with any questions.

If your child has a more complicated health condition, please contact the District Nurse to discuss your child’s health care needs at school.

Epinephrine Auto-Injectors

Students with prescribed epinephrine auto-injectors may store them in the school’s front office for use during an anaphylactic emergency. A student may self-carry an epinephrine auto-injector if their health care provider clears them to do so. For either of the above scenarios, the family and physician must complete the appropriate documentation: Emergency Care Plan- Allergy and Anaphylaxis. If a student also uses a rescue inhaler as part of their anaphylactic treatment, then an additional form must also be completed: Emergency Care Plan- Asthma.

Each of the school buildings will maintain a small stock of epinephrine auto-injectors for use during an anaphylactic emergency. The elementary and middle schools will maintain both adult and junior doses of that medication; the high school will maintain adult doses. These auto injectors are provided to the school by the EpiPen4Schools Program and are prescribed by our District’s Medical Advisor. Designated staff at each building are trained by the District Nurse regarding the proper use of epinephrine. These stock supply auto-injectors do not accompany field trips, however a student’s prescribed auto-injector will accompany him/her on any field trip. Any questions or concerns about the use of epinephrine auto- injectors in the school setting can be directed to the District Nurse or the Building Administrator.
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