Health Forms

Commonly Used Health Forms

Universal Health Form used for physicals in Pre-school through Grade 5

Physical Examination Form

Health History form to be completed for new Pre-K students 

Pre-K Health History and Assessment

Physical Exam form for Holdrum students

Annual Athletic Pre-Participation Physical Examination Form

Must be completed for participation in sports/intra-murals

The History Form must be completed and signed by both the parent and the athlete.

The Physical Examination and Clearance Forms must be completed and signed by the physician.

This form is also required for admission to Holdrum

Health History Update form to be completed if physical is more than 90 days old

90 Day Health Histroy Update Form

Form to be completed for administration of medications in school

Medication Authorization Form 

(One form necessary for each medication)

Necessary for any student who requires asthma medication while in school

Asthma Action Plan

Necessary for any student with a food allergy that requires an epi-pen and special accommodations while in school

Allergy Action Plan

Necessary for any student with a seizure disorder

Questionnaire for Parent of a Student with Seizures

Seizure Action Plan

To be completed when your child visits the dentist

Dental Form

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