Optional Forms for Grades 1-5

These 2023-24 Forms are Optional. Complete as Needed.

Contact the school for any other health concerns not listed here.

1) General Health Form

  •  
    • PDF Form: A paper copy must be printed and completed. Physician or healthcare provider signature is required.
    • This form is required for all kindergartners and new students. For grades 1-5, it is required only if your child has special medical needs or receives medication at school.

This form must have a physician’s or health care provider’s signature.

>>> One-time form (not needed annually unless health needs change)

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail a copy to River Grove, PO Box 178, Marine on St Croix MN 55047
* Upload a copy via this form

 

2) Prescription Medications 

  •  
    • PDF Form: A paper copy must be printed and completed. Physician or healthcare provider signature is required.

For any prescription medications to be given at school. Must be signed by a medical professional.

This form must be updated annually.

>>> Click here to open the 2023-24 .pdf form

Print, complete, and send form to office. Physician’s signature required.

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail a copy to River Grove, PO Box 178, Marine on St Croix MN 55047
* Upload a copy via this form

 

3) Non-Prescription Pain Relievers

  •  
    • On-Line Form: Complete and submit on-line.

For medications such as Tylenol and Advil. All medications must be supplied by the parent/guardian.

>>> Click here to open the 2023-24 online form

 

4) Asthma Questionnaire and Emergency Care Plan  

  •  
    • PDF Form: A paper copy must be printed and completed. Physician or healthcare provider signature is required.

This form must be updated annually.

>>> Click here to open the 2023-24 .pdf form

Print, complete, and send form to office. Physician’s signature required.

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail a copy to River Grove, PO Box 178, Marine on St Croix MN 55047
* Upload a copy via this form

 

5) Authorization for Self-Administration of Asthma Medication  

  •  
    • PDF Form: A paper copy must be printed and completed. Physician or healthcare provider signature is required.

This form must be updated annually.

>>> Click here to open the 2023-24 form

Print, complete, and send form to office. Physician’s signature required.

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail a copy to River Grove, PO Box 178, Marine on St Croix MN 55047
* Upload a copy via this form

 

6) Serious Health Conditions 

  •  
    • On-line Form:  Complete and submit on-line.

This form must be updated annually.

>>> Click here to open the 2023-24 online form

 

7) Special Diet Statement

For dietary accommodations such as gluten-free; form must be completed by a medical professional.

  •  
    • PDF Form: A paper copy must be printed and completed. Physician or healthcare provider signature is required.

Updates to this form are required only when a participant’s needs change.

>>> Click here to open the .pdf form

Print, complete, and send form to office. Physician’s signature required.

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail a copy to River Grove, PO Box 178, Marine on St Croix MN 55047
* Upload a copy via this form

 

8) Seizures 

  •  
    • PDF Form: A paper copy must be printed and completed. Physician or healthcare provider signature is required.

This form must be updated annually.

>>> Click here to open the 2023-24 .pdf form

Print, complete, and send form to office. Physician’s signature required.

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail a copy to River Grove, PO Box 178, Marine on St Croix MN 55047
* Upload a copy via this form

 

9) Diabetes (Injection or Pump) 

  •  
    • PDF Forms: A paper copy must be printed and completed. Physician or healthcare provider signature is required.

This form must be updated annually.

Print, complete, and send form to office. Physician’s signature required.

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail a copy to River Grove, PO Box 178, Marine on St Croix MN 55047
* Upload a copy via this form

 

10) Allergies/Anaphylaxis

  •  
    • PDF Form: A paper copy must be printed and completed. Physician or healthcare provider signature is required.

This form must be updated annually.

>>> Click here to open the 2023-24 .pdf form 

Print, complete, and send form to office. Physician’s signature required.

* Fax a copy to 651-538-1022, or
* Scan and email a copy to forms@marineareaschool.org, or
* Mail a copy to River Grove, PO Box 178, Marine on St Croix MN 55047
* Upload a copy via this form

 

Forms Menu
  • Kindergarten Forms for Individual Students
  • Grades 1-5 Forms for Individual Students
  • Family Forms (Single Forms for All Students in the Family)
How to Turn in Completed Forms

There are two types of forms:

  • 1) Forms in .pdf format generally require signatures from physicians or other personnel. For the .pdf forms, please submit to River Grove in one of these ways:
  • 2) On-line forms are sent automatically to River Grove. You do not need to print and send them into the office.
    • Please complete the on-line forms on a computer, not a smart phone.

Comments are closed.