Student Information

(2-letter State Abbreviation)​​​

Parent/Guardian 1 Information

Parent/Guardian 2 Information

Additional Emergency Contacts

Additional Emergency Contact 1 Information

Additional Emergency Contact 2 Information

Medical Information

Please list:

If your child requires the use of ANY medication during school or after school, you must fill out school provided forms and supply medication to the main office (one form per medication). Medications for potentially life-threatening situations such as asthma or allergic reactions require additional forms. It is highly recommended that if your child carries an inhaler or Epipen, you supply the school with a second inhaler and/or Epipen to keep in the office. Forms are available online and in the main office.

I give permission to share medical information as needed with the appropriate personnel. I give our consent for school personnel, coaches, and trainers to use their judgment in the application of first aid treatment and in securing medical aid and ambulance service as necessary.

By entering my name and date and submitting this form, I agree to the statement.​​​

Please provide an email address where we can send a link to your current form.

Email Address :