HEALTH OFFICE - Back to School Forms

Medication Forms - New medication forms must be completed and turned in to your child's nurse each school year.

	Asthma Asthma Health History (to be completed by parent) Asthma Treatment Plan (to be completed by healthcare provider and signed by parent)
	Food Allergies Allergic Reaction History (to be completed by parent) Allergy-Anaphylaxis Action Plan (page 1 to be completed by healthcare provider, page 2 completed and signed by parent)
	Other Medications Daily, PRN, and Over the Counter Medication Form (to be completed by healthcare provider and signed by parent) Seizure Action Plan (to be completed by healthcare provider) Seizure History Questionnaire (to be completed by parent)
	Procedures Procedure Authorization Form

Other Forms
	Immunization Documentation Influenza Vaccine, Preschool only Grade 6 Required Immunizations - provide proof of immunization: Meningococcal vaccine Tdap vaccine
	SPORTS JP Case - Athletic Registration *RFIS -* Medical Forms for Sports Participation (6^th Grade Only) 1. Pre-Participation Sport Physical Evaluation: PPE History Form (English \| En Espa ñ ol- to be filled out by parent and submitted to physician Annual Athletic Pre-Participation Physical Examination Form - submit to physician PPE Medical Eligibility Form - this form is returned to RFIS Physical examinations are good for one calendar year. 2. Health History Update Questionnaire: (English\| En Español) Form is to be completed by parent or guardian. This form is required for each sport season. Health History Update Questionnaire must be signed and dated within 90 days prior to the first practice session. Sudden Cardiac Death Sign-Off Form (N.J.S.A. 18A:40-41d) (English \| En Español) Concussion Fact Sheet and Acknowledgement Form Opioid Use & Misuse Sign-Off Sheet (English \| En Español)
	INFORMATION SHEETS (State of NJ DOE) Sudden Cardiac Death in Young Athletes Brochure (English \| En Español) Concussion Fact Sheet and Acknowledgement Form Opioid Use & Misuse Fact Sheet (English \| En Español) Sports-Related Eye Injuries Fact Sheet for Parents/Guardians (N.J.S.A. 18A:40-41.9)

	School Registration The following forms are required for your child's entry into the District -- a physical exam appropriate for your child's grade and a student health history: PreK-Grade 4 Physical Exam Form (Pre-K through 4th grade) (to be completed by your child's health care provider) ~ AND ~ Student Health History (to be completed by parent) Grades 5-8 PREPARTICIPATION PHYSICAL EVALUATION: History Form (Spanish), Exam Form (to be completed by your child's healthcare provider and parent)