Commonly Used Health Forms

Health/Physical Exams: 

Students participating in middle school, high school and/or Minnesota State High School League Sports are required to have a physical exam on file that was performed within the last three years. This physical exam must be on file in the student health record.

1. Minnesota State High School League Sports Physical Form

Immunizations:

1. Pre-Kindergarten - 12th Grade Immunization Record (includes child care & conscientious objection to immunizations)

Authorizations/Releases/Consent forms:

1. Authorization for the Administration of Medication/Treatment
2. Release of Information (ROI) Authorization
3. Self-Administration of Medication Authorization (completed by health care provider)
4. Self-Carry, Self Administration of Over the Counter Pain Medication (secondary students only)
5. Overnight Field Trip Authorization

Specifically for students with anaphylaxis, asthma, diabetes, and/or seizures:

1. Authorization for the Administration of Medication/Treatment
2. Self-Carry, Self-Administer Medication Agreement
3. Allergic Reaction Questionnaire 
4. Asthma/Breathing Questionnaire
5. Diabetes Questionnaire
6. Seizure Questionnaire

Contact your health care provider to obtain a copy of your child's anaphylaxis, asthma, diabetes, and/or seizure action plan. Provide a copy to the health office at your child's school.

Special Dietary Needs/Forms

Many of today's students have special dietary needs. SPPS Nutrition Services' website offers varied information on how it manages specific food allergies and intolerances. Families are asked to complete a Special Diet Statement, that must be signed by a licensed physician and can be found at the bottom of the main Nutrition Services webpage. Families are also reminded to communicate diet needs and accommodation information to school health office staff.

Link to SPPS Nutrition Services

Completed forms can be emailed to: student.wellness@spps.org