Commonly Used Forms

Commonly Used Forms



In This Section Section Home Mental Health Support Services Commonly Used Forms Illness and Communicable Disease COVID-19 Resources Immunizations Needed for School Taking Medicine in School Section 504 Resources for Parents Safe and Sound Services Resources for Healthy Living Find Mental Health & Substance Use Openings School Based Clinics	Commonly Used Forms Health Services > Commonly Used Forms Commonly Used Forms Childhood Immunization form (New 1-14): Required for all children who attend MPS early childhood family education (ECFE), early childhood special education (ECSE), school readiness programs, and other school district preschool and pre-kindergarten programs. Schools will accept other versions of immunization records, too as long as all required immunizations are listed. For more information on Immunization Requirements, see the section titled, Immunizations Needed for School. Health Information form: Requested for all new students to MPS and those entering kindergarten, middle or high school, to let health office staff know about health issues that might interfere with learning or which may result in an emergency during the school day. This form is also available in Spanish, Hmong, and Somali. Medication Consent form:This form is a way for the parent/guardian and health care provider to authorize the school to give medicine to a student during the school day. Authorization is required for any prescription or over the counter medication. This form is also available in Spanish. Medical Procedure/Treatment Consent form: Parents/guardians requesting specialized health care procedures (such as G-tube fdgs, catheterization, tracheostomy cares) to be administered by school staff are required to provide annual written permission signed by the parent/guardian and the childs health care provider. Self-Carry Consent form: This form can be signed by parents/guardians to allow secondary students to self-carry nonephedrine over-the-counter pain medication such as Tylenol or Advil. See section on taking medication in school for more information. This form is also available in Spanish, Hmong, and Somali. Student Face Covering Medical Exemption form: Students who cannot wear a face covering due to a medical, developmental, or behavioral condition may be exempt from wearing a face covering in school. Student Immunization Reporting form (New 1-14): This form can be used to document vaccinations and/or to claim an exemption from the requirements for medical reasons or the conscientiously held beliefs of the parent/guardian. This form reflects the new immunization requirements for schools beginning September 1, 2014. There is also an Early Pysical Exam Form: Take the appropriate physical exam form with you when your child goes for a check up and return it to the school. Checkups are strongly recommended for students entering kindergarten and 7th grade. Students who want to play sports in middle and high school must have a physical examination on record with the coach before they can play. Physical Exam Form Grades PreK - 5th Physical Exam Form Grades 6th-12th A copy of the Sports Qualifying Physical Examination form can be obtained from the Athletics Department website.