Horace W. Porter

School Health Forms

Directions: Click the form title to access a printable version of each form.

1. Physical
- the health form is required for entry into Preschool, Kindergarten, and during the 6th grade year. The parent fills out the front of the form and the doctor fills out the rest. A complete list of all vaccinations should be written on the form or attached to the form. Once the form is completed, please return to it to the school nurse before the date the child is to start school.

2. Annual Health Update - The double-sided form is required yearly. The parent fills it out and signs it. It should then be returned to the school with the other beginning-of-the-year forms. It is very that the nurse be made aware each year of any medications, allergies, or medical conditions that your child has. This form also lets the nurse know if you give permission for the administration of Tylenol/Motrin, and for 5th-8th grade, if you want your child screened for scoliosis.

3. Religious Exemption Form - The two-page form needs to be filled out if you choose not to vaccinate your child either for all vaccines or just specific ones. The form needs to be submitted to the school nurse before enrolling your child for the first time and then renewed again before your child enters seventh grade. The parent/guardian signature needs to be witnessed by one of the officials listed on the second page of the form.

4. Authorization for Medicine to Be Administered at School - The form is needed if you want the nurse to give your child medication at school. This includes over-the-counter medication EXCEPT Tylenol and Motrin. The doctor fills out the top and the parent fills out the middle portion. If the doctor and the parent feel the child is capable of carrying their own medication (inhaler or EpiPen) then they should also fill out the bottom. The nurse will do training with the student to assess his/her ability to self-carry. Once this form is filled out it should be returned to the nurse.