Health Room Forms

Please click on the following links to download each health form:

If your child requires any medication, prescription or over-the-counter, during school hours, a Medication Authorization form must be completed by your medical provider and signed by a parent/guardian each school year.

• Authorization for Medications in School
• Physical Exam Form
• Private Dentist Form
• Asthma Care Plan Form
• Concussion Management Forms
• Seizure Action Plan
• Sunscreen Parent Form
• SUN SCREEN Student Form
• Allergy and Anaphylaxis Emergency Plan*THIS FORM MUST BE COMPLETED FOR ALL EPINEPHRINE (EPIPEN) ORDERS.
• Medical Plan of Care for School Food Service (Milk intolerance/allergy) 
   *Note this must be signed by a physician each school year.
• Exemption to Immunization and/or Healthcare Intervention for KASD Students

If your child has any medically necessitated dietary restrictions, such as food allergy, intolerances or restrictions your physician must complete the attached form each school year for the food services to provide an alternate meal item: 

Sunscreen should be kept in your child's backpack, along with the completed forms, in a labeled Ziplock bag.