Health Services Forms
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Guidelines for Parents on Keeping Ill Students Home
GUIDELINES FOR PARENTS ON KEEPING ILL STUDENT HOME.pdf 327.39 KB (Last Modified on November 27, 2018) -
Student Medical Health History Record Form - Confidential - English
Completed during registration.
Student Health Questionnaire - Confidential 2020-2021 filable form.pdf 196.92 KB (Last Modified on November 19, 2019) -
Student Medical Health History Record Form - Confidential - Spanish
Completed during registration
Student Health Questionnaire - Confidential 2020-2021 SP fillable.pdf 195.78 KB (Last Modified on November 19, 2019)
Athletic Sports Teams
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Athletic Sports Physical & Consent and Liability Release Form - English
Parent and student signature required
Health Exams, Immunizations, & Oral Assessments
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Guide to Immunizations Requirement for TK/K-12 - English
IMM-231 CA Immunization Requirement for K-12 rev 1-2021.pdf 60.59 KB (Last Modified on January 15, 2021) -
Guide to Immunizations Requirement for TK/K-12 - Spanish
IMM-231S CA Immunization Requirement for K-12 rev 1-2021.pdf 60.76 KB (Last Modified on January 15, 2021) -
Report of Health Examination for School Entry - CHDP -1st Grade Requirement
Report of Health Examination for School Entry pm171a 2007.pdf 162.73 KB (Last Modified on November 6, 2018)
Medication, Asthma Care Plans, Diabetic Management Plan & Anaphylaxis Treatment Plans
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Authorization for Medication Taken During School Hours, School Activities, and Field Trips
Required form for any medication taken at school. This form is only good for one school year. New form needed for each school year.
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Diabetes Medical Managment Plan
Required form for a Student with Diabetes
DMMP - Diabetic Medical Management Plan 2020-21 Fillable.pdf 504.22 KB (Last Modified on October 14, 2020) -
Food Allergy and Anaphylaxis Emergency Care Plan
Required form if a student has a Epipen or Auvi-Q at school
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Medication Guidelines and Procedures Parent Information
This is guidelines and procedures for medication taken during school hours.
5141.21 E-1 2020 w-sp Medication Guidelines and Protocols.pdf 591.93 KB (Last Modified on August 26, 2020) -
School Sponsored Trips and Off-Site Activities Release for Students with Diabetes
Diabetes Trip-Activity Release w-sp 2019 fillable form.pdf 127.63 KB (Last Modified on August 27, 2020) -
Student Agreement Asthma Mangement in School
Required if student will be carrying inhaler
5141.23 E-2 Student Agreement Asthma Management 1-2018 w-SP.pdf 215.44 KB (Last Modified on November 6, 2018)