Select an applicable form, if your child requires a plan or treatment at school. Forms must be completed and signed by a parent/guardian and the medical provider.
Return completed Plan to the School Nurse.
(For students with allergy/anaphylaxis medication in school, i.e. epi-pen, antihistamine)
(For students with asthma medication in school, i.e. inhaler)
- Diabetes Injection Care Plan (For student with diabetes medication/insulin injection in school)
- Diabetes Pump Care Plan (For student with diabetes medication/insulin pump in school)
(For student with seizure medication in school, i.e. Diastat rectal gel)
Special Meal or Accommodations Request
New or Changed Meal Accommodation Request. (Existing Requests do not need to be submitted)
(For students requiring special dietary needs)
(Contact school nurse to determine if a doctor’s signature is required)