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Printable Health Forms



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Goldenrod
This form is used as a screening tool and sports physical. As a screening tool, the form needs to be completed by a parent/guardian prior to each sport's season, if a health appraisal has not been done in the last 30 days. As a sports physical form, it needs to be filled out by a physician/healthcare provider, to certify that a student-athlete may participate in sports activities. A sports physical is valid for a period of 12 months and through the entire sports season.

Authorization for Administration of Medication in School
This authorization form needs to be completed by your child's healthcare provider and requires a parent signature. An Authorization for Administration of Medication in School form is needed for each medication ordered by the physician and is renewed each school year or as the medication changes. (Further information, see Health Section in Student Handbook)

Required NYS School Health Examination Form
By New York State regulations: Each student enrolled in the public school shall have a satisfactory health examination conducted by the student's family physician, physician assistant or nurse practitioner, upon the student's entrance in such school at any grade level and for each student entering pre-kindergarten or kindergarten and in the 2nd, 4th, 7th and 10th grades. The completed form(s) need to be mailed, faxed or delivered to the school health office and become part of the student's medical record.

Pupil Benefits Plan Form
Student Accident Insurance is an "excess" coverage plan. It complements your primary insurance plan coverage for medical expenses following an accidental injury during school, traveling to and from school or participation in other school sponsored activities.