Health Forms

All forms should be returned to the STA Health Office

The two-page form below needs to be filled out every year for every student. The first page authorizes the school health staff to share health concerns with appropriate school personnel who have direct contact with your son during the school day, and provides your consent for the health staff to administer Ibuprofen/Tylenol. The second page is emergency contact information. Again, this two-page form must be filled out every year for every student. 

2011-12 Two-Page Form Regarding Student Health Data [pdf]

2011-12 Student Health Form [pdf]
This form is for NEW STUDENTS ONLY.

Forms for all students in grades 7-12.
A physical exam is required every three years.

2011-12 MSHSL Athletic Eligibility Brochure [pdf]

2011-12 MSHSL Qualifying Physical Examination [pdf]

2011-12 MSHSL Eligibility Statement Concussion Management Addendum [pdf]

Consent For Administration of Medication in School [pdf]
This form must be signed by both the parent and the physician in order for your child to receive medication (other than Ibuprofen/Tylenol) in school. Only medications prescribed by a physician, in writing, will be dispensed in the Health Office. This includes all over-the-counter medications.

Immunization Form [pdf]
This form can be used if you do not have one from your doctor.

Allergy Form

• Allergy Action Plan [pdf]
  This form must be completed by a physician and parent/guardian. Orders must be renewed annually.
  
  

  Asthma Form

• Asthma Action Plan [pdf]
  This form must be completed by a physician and parent/guardian. Orders must be renewed annually.
  
  

  Diabetes Forms

• Independent Blood Glucose Monitoring Authorization [pdf]
  This form must be completed by a physician and parent/guardian. Orders must be renewed annually.

• Diabetes Care Plan [pdf]