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 History 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