Medication Permission Form

click here for the medication permission form

This permission form should be completed when requesting medication be dispensed to your child during the school day.

 

Camp Kon-O-Kwee Medication Form

click here for the Camp KOK Medication form

This permission form should be completed when requesting medication to be dispensed to your child during Camp KOK.

 

Allergy Action Plan

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This form should be completed by you and your child’s physician indicating the steps to be taken if your child has a life threatening allergy. It’s important to note that if Zyrtec or Benadryl are a part of the plan, the physician should include the written prescription for that medication.

Please note that the district has Epinephrine available in all the District Health Offices, in case of an emergency.  The Pennsylvania Public Code School Code Section 1414.2(g) allows parents/guardians to request an exemption to the administration of an epinephrine auto-injector for their child.  In order to request this exemption, contact the school nurse to make an appointment to discuss this decision, review, and sign the opt-out form.  

 

Asthma Action Plan

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This form should be completed by you and your child's physician indicating the steps to be taken if your child has an episode of asthma.

 

Physical Exam Form

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This form should be completed by your child's Primary Health Care Provider for entry into school (Kindergarten or 1st grade), before starting 6th grade, and before starting 11th grade.

 

Dental Form

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This form should be completed by your child's dentist for entry into school (Kindergarten or 1st grade), before starting 3rd grade, and before starting 7th grade.

 

Absence Notes

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Print this form when sending in an excuse for your child's absence. A written excuse is required for each absence.

 

NA Physical Education CAN DO List

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This form can be used for the health care provider to specifically list what can be done in PE if restrictions need to be in place.