Student Health Information and Forms


Below are the health forms needed for your child at Sargent Public School.   The school nurse’s are Kristin Slagle and Mary McDaniel.  We work on a as needed basis so if you need to contact us, please call us at home or call the school and we will return your call.

Most physician’s offices have a computerized form that they send for the physical so we do not have a form for this.

Please contact the school if you need further information.

Checklist for new students  – a checklist of the required forms for students

New Student Letter – a letter about what you can expect from the school nurse.


School Immunizations Rules & Regulations English

School Immunizations Rules & Regulations-SPAN

Physical and/or Eye Exam Waiver

Yearly Update Health Questionnaire – a short questionnaire that asks about allergies (food and environmental) and other health conditions  that your student may have so that we can provide care/training as needed.  We request that parents fill it out yearly as the health of your student may change from year to year.

                                                          Yearly Health Update.pdf

School Vision Evaluation Form – new students entering Kindergarten and out-of-state transfer students are required to have documentation of a vision exam within the last 6 months.  This test may be performed by a physician but eye health (internal and external), strabismus and amblyopia must be assessed.

Documentation of Varicella (Chickenpox) – If your child has had the varicella (chickenpox) disease, we must have documentation

Authorization for Medications – If your child needs to take medication during school, this form needs to be completed.  All medications are kept in the main office and are administered by staff that has completed some medication training.  Medications must be sent in an original container with the name of the medication, dosage and timing of medicine and students name clearly marked.  If medications are on a as needed basis, we will send a form home with your child if the medicine was given for medicines such as Tylenol or Ibuprofen.  However, if you are requesting that a medication be given at specific times, we will not send home a form but will contact you if your child did not receive it or is refusing the medication.  Cough drops may be kept in the classroom if you child’s  teacher wishes.  Please talk to them about their preferences.  If medications will be sent home at the end of the school year with your student unless you contact the school requesting something different.

Request to Provide Tylenol, Ibuprofen Medication, Antibiotic Cream & Cough Drops During School Hours – This is the form to complete for students to receive Tylenol, Ibuprofen, Antibiotic Cream, and Cough drops from the school supply. We will still attempt to contact you prior to your student receiving a dose.

Food Allergy Action Plan

Students are not allowed to carry their own medications unless it is for asthma or diabetes, there are special forms for these.

Asthma Allergy Action Plan – This form is for all students who have asthma or allergies that require emergency medications to be given.  It needs to be signed by a Physician, Physician’s Assistant, or Nurse Practitioner.  It MUST Be Completed yearly if your child would like to Self Carry An Inhaler or other emergency medication.  Even if your child only uses the inhaler on an as needed basis.

Asthma Allergy Action Plan

Asthma Allergy Action Plan – Spanish 

Refusal of Immunizations Medical – Must be signed by a physician.  

Refusal of Immunizations Religious – Must be notarized.  

Form for special meals – If your child has health issues that require special meals, this form must be completed by your physician.  

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