Medical Information Form
As we begin the new school year we are asking you to update the medical information for your child. Over time, the information we rely on in Alma (our student information system) may have become outdated. Once you fill out and submit this form the information will be updated in your child’s student profile in Alma. Should it become necessary, we will rely on the information in your student’s profile to make decisions and react to the needs of your child.

Most medications prescribed by your physician for your child will be able to be administered by you at home before or after school hours. We understand, however, that this is not always the case. We can accommodate if your child has the need for medication to be stored in the front office and for it to be dispensed to your child by our front office staff. For a medication that falls in this category, please submit it to the front office where you will be asked to fill out a separate form for each medication. There are specific requirements for this medication and its disbursement that can be described further by the front office staff.

*Parents with multiple students, please submit another form. After you submit, there will be a link to fill out another form on the next page.

First Name *
Your answer
Last Name *
Your answer
Confirm your relationship with the students that you are filling out this form on behalf of:
Student First Name *
Your answer
Student Last Name *
Your answer
Grade *
List any and all allergies this student has that we should be aware of (if there are none mark none in the box): *
Your answer
Does your child carry and self-administer their own Epipen? *
List any and all medications that we should be aware of that this student is currently taking or would otherwise be prescribed (if there are none mark none in the box): *
Your answer
List and describe any other medical needs that this student has and that we should be aware of. Describe how this medical condition might impact the student’s abilities or activities at school, in sports, or related to foods: *
Your answer
If your child requires minor first aid we can provide the following. Indicate your approval (yes) or your disapproval (no) for the administering of the following over the counter minor first aid products. These products are administered in accordance with the directions on the manufacturer’s packaging. *
For students 12 years and older:
Equate brand Acetaminophen
Advil
For students age 5-11 year:
Children’s Liquid Tylenol
All Students of All Ages:
Halls Lemon or Cherry cough drops *
Isopropyl Rubbing Alcohol (liquid or pads) *
Rexall Antibiotic Ointment *
Calaclear anti itch lotion *
A note about other students that have severe allergies:
We do have students with life-threatening food allergies on campus this year. Ingestion of certain allergens or products of (butter, flour, oil) can initiate an anaphylactic (shock) reaction. Anaphylaxis affects the entire body that can result in breathing and heart problems and potentially death. Strict avoidance of the allergy-causing food is the only way to prevent a reaction. For more detailed information on what kind of snacks that can be brought to school go to https://www.dropbox.com/s/tko3hmxfe94ttct/Peanut%20Allergy%20Letter.pdf?dl=0 .
*Parents with multiple students, please submit another form.
After you submit, there will be a link to fill out another form on the next page.
Submit
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