Optional Forms for Grades 1-6

These 2022-23 Forms are Optional. Complete as Needed.

Contact the school for any other health concerns not listed here.

1) General Health Form

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

(This is a .pdf form. A paper copy must be printed and completed. Physician or health care provider signature is required.)

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

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail or bring a copy to River Grove, 14189 Ostlund Trail N., Marine on St Croix MN 55047

2) Prescription Medications

(Print, complete, and send form to office. Physician’s signature required.)

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

This form must be updated annually.

Click here to open the 2022-23 form: http://www.marineareaschool.org/wp-content/uploads/H05_PrescripMedicationsAtSchool_22-23.pdf

Print, complete, and send form to office. Physician’s signature required.

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail or bring a copy to River Grove, 14189 Ostlund Trail N., Marine on St Croix MN 55047

3) Non-Prescription Pain Reliever

(Print, complete, and send form to office.)

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

Click here to open the 2022-23 form: http://www.marineareaschool.org/wp-content/uploads/H06_OTC_Pain_Relievers_at_School-22-23.pdf

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail or bring a copy to River Grove, 14189 Ostlund Trail N., Marine on St Croix MN 55047

4) Asthma Questionnaire and Emergency Care Plan

(Print, complete, and send form to office. Physician’s signature required.)

This form must be updated annually.

Click here to open the 2022-23 form: http://www.marineareaschool.org/wp-content/uploads/H07_AsthmaQuestionnaire_2022-23.pdf

Print, complete, and send form to office. Physician’s signature required.

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail or bring a copy to River Grove, 14189 Ostlund Trail N., Marine on St Croix MN 55047

5) Authorization for Self-Administration of Asthma Medication

(Print, complete, and send form to office. Physician’s signature required.)

This form must be updated annually.

Click here to open the 2022-23 form: http://www.marineareaschool.org/wp-content/uploads/H08_Authorization-for-Self-Administration-of-Asthma-Medication_2022-23.pdf

Print, complete, and send form to office. Physician’s signature required.

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail or bring a copy to River Grove, 14189 Ostlund Trail N., Marine on St Croix MN 55047

6) Serious Health Conditions Form

(Print, complete, and send form to office.)

This form must be updated annually.

Click here to open the 2022-23 form: http://www.marineareaschool.org/wp-content/uploads/H09_SeriousHealthForm_2022-23.pdf

Print, complete, and send form to office.

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail or bring a copy to River Grove, 14189 Ostlund Trail N., Marine on St Croix MN 55047

7) Special Diet Statement

For dietary accommodations such as gluten-free; form must be completed by a medical professional.

(Print, complete, and send form to office. Physician’s signature required.)

Updates to this form are required only when a participant’s needs change.

Click here to open the form: http://www.marineareaschool.org/wp-content/uploads/2020/11/Special-Diet-Statement-MDE060182.pdf

Print, complete, and send form to office. Physician’s signature required.

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail or bring a copy to River Grove, 14189 Ostlund Trail N., Marine on St Croix MN 55047

8) Seizures

(Print, complete, and send form to office. Physician’s signature required.)

This form must be updated annually.

Click here to open the 2022-23 form: http://www.marineareaschool.org/wp-content/uploads/H10_SeizureEmergencyCarePlan_2022-23.pdf

Print, complete, and send form to office. Physician’s signature required.

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail or bring a copy to River Grove, 14189 Ostlund Trail N., Marine on St Croix MN 55047

9) Diabetes (Injection or Pump)

(Print, complete, and send form to office. Physician’s signature required.)

This form must be updated annually.

Click here to open the 2022-23 form (Pump): http://www.marineareaschool.org/wp-content/uploads/H12_DiabetesEmergencyCarePlan-Pump_2022-23.pdf

Click here to open the 2022-23 form (Injection): http://www.marineareaschool.org/wp-content/uploads/H11_DiabetesEmergencyCarePlan-Injection_2022-23.pdf

Print, complete, and send form to office. Physician’s signature required.

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail or bring a copy to River Grove, 14189 Ostlund Trail N., Marine on St Croix MN 55047

10) Allergies/Anaphylaxis Form

(Print, complete, and send form to office. Physician’s signature required.)

This form must be updated annually.

Click here to open the 2022-23 form: http://www.marineareaschool.org/wp-content/uploads/H13_AllergicAnaphylaxis_form_2022-23-1.pdf

Print, complete, and send form to office. Physician’s signature required.

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail or bring a copy to River Grove, 14189 Ostlund Trail N., Marine on St Croix MN 55047

Forms Menu
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
On-line Forms:

On-line forms are sent automatically to River Grove. You do not need to print them.

Please complete the online forms on a computer, not a smartphone.

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