Parents/Guardians should provide the following at the start of each school year:

Please Note:

Some of the forms below require completion and signature of your healthcare provider as well as the parent/guardian signature.


The parent and student along with the healthcare provider and the school nurse will work together to determine if the student will self-carry and/or self-administer their reliever/rescue medication in 5th grade or higher. If a student is not able to self-carry and/or self-administer rescue medication, such medications will be readily accessible to the student and appropriate staff trained in administration.

If it is determined that a student will self-carry and/or self-administer in addition to the above forms the health office will also need:

Self Carry

To be completed and signed by your healthcare provider