Below, you will find forms you can download and print at home.

vision referral(doc file - 31kb)
take this form if your child is going for an eye exam

Information regarding Medication 

A school nurse is prohibited by NYS Education law from dispensing medication to school children without specific doctor’s order. A doctor's order with instructions for use and a parental signature is required for ALL medication given during school hours. This includes over the counter and prescription medications. Please see forms below for a doctor’s order form if needed.

An adult MUST deliver medication(s) to the nurse’s office in their original container. Students are not allowed to carry any medication to school. (See the district calendar for more details.)

At the end of the school year a parent or designee MUST pick up their child’s medication or it will be discarded. We are unable to store medication over the summer.

New medication and orders will be required at the beginning of each school year. Orders DO NOT carry over from one school year to the next. Click on the link below for the forms you and your doctor will need to fill out.

Please notify me regarding any changes in medical conditions, such as prescription changes, allergies to medications, insects, or other existing conditions. This info is kept confidential and is available only to staff and special teachers on a need to know basis.

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doc file: You need the Microsoft Word program, a free Microsoft Word viewer, or a program that can import Word files in order to view this file. To learn more about the free Microsoft Word Viewer, visit the Microsoft Word website.

Related Files

physical exam form1.pdf

form for prescribed medications.pdf

student emergency action plan (seap).pdf