Important Medical Forms
District Medication Policy - All medications require a primary care provider’s order and must be in the original pharmacy labeled container with your child’s name on it.
Request for Medication Administration - This form is REQUIRED to be filled out by your family physician, and must be signed and stamped by the physician's office when you child need to take medication while at school.**Do not use this form for students who require inhalers or epi-pens. Special forms have been developed for those medications,and they are available further down on this page.** All medication at school must be given by the Nurse, including over the counter medication. All medications (including over the counter medications) require a doctors written order, medication in the pharmacy labeled container, and parents written permission for administration. All forms can be downloaded at the bottom of this page. Medication must be brought to school by an adult. Please do not send it in with your student.
Allergies Forms - If your child has any type of allergy (food, latex, etc.) you will need to fill out the allergies forms and return to the school nurse at the start of each school year. You will need parts of the form to be filled out by your family physician, and must be signed and stamped by the physician's office.
Bee Sting Allergy, Please Complete the Epi-Pen Packet (*)Food Allergy Questionnaire
Asthma Forms - If your child has any type of asthma or Reactive Air Way Disease you will need to fill out the asthma forms and return to the school nurse at the start of each school year. You will need parts of the form to be filled out by your family physician, and must be signed and stamped by the physician's office.
Diabetes Forms - Please contact the nurse's office concerning any diabetic forms. Most doctors’ offices will only use their forms concerning diabetic students. We will accept your doctor’s forms as long as no important information is missing per state law. If any needed information is missing, we will give you that section for your doctor to complete.
Pemberton Township Local Health Resources - This is a resourceful form that list many different services and medical providers available, including types of insurances they accept and for individuals who currently do not have insurance.
Due to limited resources and very limited space, it’s important for you to keep your sick child at home. We’ll work with you by keeping your healthy child in school and calling you only when we feel it is necessary for you to know of an injury or for your child to be sent home. Please review the Student Handbook – Health Section and it should be able to answer any questions you may have concerning medical issues at school.Please remember to update your emergency phone number as changes occur. Send in new phone numbers and contact information with your child. Any students with asthma, food allergies, or bee sting allergies need to submit medical paperwork for the current school year.
Important Medical Forms & Information
Elementary School Handbook Health Section
District Medication Policy
Food Allery Network
Immunization Requirements Letter
Middle School Sports Letter
Middle School Sports Form
Pemberton Twp. Health Resources
Request for Medication Administration
Sports Related Eye Injuiry
Universal Child Health Record
Please contact your child's school nurse if needed for detailed explanation of all medical forms and school health services and regulations.
Shannon Horton, BSN, RN, CSN
Alexandar Denbo Upper Elementary School Nurse