Health Service Forms

Below you will find printable forms that may be helpful if you child has a specific health need while at school. You may also pick them up at your school's main office if you are unable to print at home.

Allergy Action Form

Please have your child's physician fill out this form for any life-threatening allergy. This form needs to be filled out every school year.

Asthma Action Plan

Please have your child's physician fill out this form for asthma. This form needs to be filled out every school year.

Assistive Devices

If your child needs to use any assistive devices while at school (such as crutches or a wheelchair), their physician needs to fill out this form and parent/guardian to return to school.

Meal Accommodations

If your child has food allergies and participates in school lunches, this form will notify nutritional services of their needs. School lunches cannot be amended without this state approved form. Once your physician has filled out the form, return it to the school. Meal changes will remain in effect while your child is at Sylvan Union School District.

PE Accommodations

If your child has an injury or medical condition that prohibits them from participating fully in the Physical Education class, this form must be filled out by their physician. Make sure the physician indicates on the form whether the accommodations are for the entire school year or specific dates. This form is more commonly used at the middle schools.

Medication Administration Form

This form is required by the State of California for any medication that will be given or brought on campus. This includes prescription and over the counter medications such as cough drops and Tylenol. The form needs to be filled out every school year. All medications are provided by the parent and must be given to the health office in their original container with the pharmacy label on it (for prescribed medications). Medications not picked up at the end of the school year will be properly disposed of by health staff.

Release of Information

Due to confidentiality laws, School Nurses (and other staff) must have written permission from the parent/guardian to communicate with others regarding your child's health history. The release of information gives the Nurse (or whomever you list) permission to communication with other programs, physicians, and facilities outside of Sylvan Union School District. As the parent/guardian, you choose with whom they may communicate with. The form is valid for the current school year and the parent/guardian may resend their permission at any time.