Optional Forms for Grades 1-6

Optional Forms for Grades 1-6

• Complete as Needed
  • Immunization Form (If necessary, print and complete this .pdf form. Make sure to sign and date side 2 of this form as appropriate.)
    • Or, instead of entering the dates on this form, your medical professional can fax the records to 651-538-1022.
    • Or, if you have your student’s immunization records, you may email them to the school.
    • For students transferring from another school, immunization records should be forwarded from your former school.
  • General Health Form (Kids needing medication administered at school and all incoming Kindergarten students need the form completed with a physician’s signature. The form is recommended for others, but not required.)
  • Prescription Medications (For prescription medications to be given at school. Must be signed by a medical professional.)
  • Non-Prescription Pain Reliever (For medications such as Tylenol and Advil. These must be supplied by the parent/guardian.)
  • AsthmaAuthorization for Self-Administration of Asthma Medication at School
  • Serious Health Conditions
  • Special Diet Statement (For dietary accommodations such as gluten-free; form must be completed by a medical professional. Updates to this form are required only when a participant’s needs change.)
  • Seizures
  • Diabetes:   Injection    Pump
  • Allergies/anaphylaxis form

Instructions for .pdf Forms

Select the sections that apply to your students/family

• Kindergarten Forms
  • Required (complete one set per student)
  • Optional (complete one form per student as needed)
• Grades 1-6 Forms
  • Required (complete one set per student)
  • Optional (complete one form per student as needed)
• Family Forms
  • Required (complete one copy of each form per family, even if you have just one student in the school)
  • Optional (complete one form per family as needed)