Optional Forms for Grades 1-6

Optional Student Forms for Grades 1-6: Complete as Needed
2020-21 and 2021-22 Forms

Contact the school for any other health concerns.

Prescription Medications

For prescription medications to be given at school. Must be signed by a medical professional.

This form must be updated annually.

2020-21 Form
http://www.marineareaschool.org/wp-content/uploads/2020/05/PrescripMedicationsAtSchool_20-21.pdf

2021-22 Form
http://www.marineareaschool.org/wp-content/uploads/H05_PrescripMedicationsAtSchool_21-22.pdf

Non-Prescription Pain Reliever

For medications such as Tylenol and Advil. All medications must be supplied by the parent/guardian.

2020-21 Form
http://www.marineareaschool.org/wp-content/uploads/OTC_Pain_Relievers_at_School.pdf

2021-22 Form
http://www.marineareaschool.org/wp-content/uploads/H06_OTC_Pain_Relievers_at_School-21-22.pdf

Asthma Questionnaire and Emergency Care Plan

This form must be updated annually.

2020-21 Form
http://www.marineareaschool.org/wp-content/uploads/AsthmaQuestionnaire-1.pdf

2021-22 Form
http://www.marineareaschool.org/wp-content/uploads/H07_AsthmaQuestionnaire_2021-22.pdf

Authorization for Self-Administration of Asthma Medication

This form must be updated annually.

2020-21 Form
http://www.marineareaschool.org/wp-content/uploads/Authorization-for-Self-Administration-of-Asthma-Medication-at-School-Name-of-River-Grove.pdf

2021-22 Form
http://www.marineareaschool.org/wp-content/uploads/H08_Authorization-for-Self-Administration-of-Asthma-Medication_2021-22.pdf

Serious Health Conditions Form

This form must be updated annually

2020-21 Form
http://www.marineareaschool.org/wp-content/uploads/SeriousHealthForm.pdf

2021-22 Form
http://www.marineareaschool.org/wp-content/uploads/H09_SeriousHealthForm_2021-22.pdf

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.

http://www.marineareaschool.org/wp-content/uploads/2020/11/Special-Diet-Statement-MDE060182.pdf

Seizures

This form must be updated annually.

2020-21 Form
http://www.marineareaschool.org/wp-content/uploads/SeizureEmergencyCarePlan.pdf

2021-22 Form
http://www.marineareaschool.org/wp-content/uploads/H10_SeizureEmergencyCarePlan_2021-22.pdf

Diabetes (Injection or Pump)

2020-21 Forms
Diabetes Emergency Care Plan
(Injection)

Diabetes Emergency Care Plan (Pump)

2021-22 Forms
Injection:
http://www.marineareaschool.org/wp-content/uploads/H11_DiabetesEmergencyCarePlan-Injection_2021-22.pdf

Pump: http://www.marineareaschool.org/wp-content/uploads/H12_DiabetesEmergencyCarePlan-Pump_2021-22.pdf

Allergies/anaphylaxis form

Questionnaire and Emergency Care Plan for Allergies and Anaphylaxis

2020-21 Form
http://www.marineareaschool.org/wp-content/uploads/AllergicAnaphylaxis_form.pdf

2021-22 Form
http://www.marineareaschool.org/wp-content/uploads/H13_AllergicAnaphylaxis_form_2021-22.pdf

General Health Form

This form must have a physician’s or health care provider’s signature.

This form is required for all kindergartners and new students. For grades 1-6, it is required only if your child has special medical needs or receives medication at school.

One-time form (not needed annually unless health needs change)
http://www.marineareaschool.org/wp-content/uploads/H03_general_health-form2-online.pdf

Click on the arrow to the right of the form title to read more or for a link to an individual form.
How to Turn in Completed .pdf Forms
  • Print, sign, and send or deliver to River Grove Forms, 14189 Ostlund Trial North, Marine on St. Croix, MN 55047
  • Complete then save with a new file name and email to forms@marineareaschool.org
  • Print, scan, and email to forms@marineareaschool.org
  • Fax to: 651-538-1022

Online interactive forms are sent automatically to River Grove. You do not need to print them.

Quick Links to More Forms

Select the sections that apply to your students/family. Please complete the online forms on a computer, not a smartphone.

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