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Harrington Park School District
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Required Forms
Health Forms
Pre-K - 5 Physical Exam Form
6-8 Physical Form/Sports Physical
Sudden Cardiac Death in Young Athletes
Sports-Related Eye Injuries
Sports-Related Head Injury and Concussion
Opioid Educational Fact Sheet
Student Athlete/Parent Sign-Off Packet (new for 2019-2020 school year)
Health History Questionnaire for Athletic Participation
This form is to be completed by parents if medical examination was completed more than 90 days prior to the first practice.
Asthma Treatment Plan
To be completed by student's health care provider. Must be renewed each school year.
Medication Authorization for Allergic Reaction
To be completed by student's health care provider. Must be renewed each school year.
Permission for Self-Administration of Medication
Permission form to carry and self-administer epi-pen or inhaler. To be completed by student's health care provider and parent.
Authorization for Nurse to Administer Medication in School
To be signed by parent and child's health care provider. Must be renewed each school year.