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AYJ Forms

Serious Medical Condition (PDF)
This form is required if you child has a serious medical condition. Please complete and sign this form annually and return it to the school office.

Severe, Life Threatening Allergy (PDF)
This form is required if your child has a severe, life threatening allergy. Please complete and sign this form annually and return it to the school office.

Emergency Use of EpiPen (PDF)
This form is required if your child keeps an EpiPen in the school office and/or on them/in their backpack. 
Your doctor is required to complete and sign the middle section of the first page. Once you have completed the rest of the first page and signed it, sign in the two places on the second page, and return the form with your child's EpiPen to the school office. This form is required annually.

Diabetes Emergency Treatment (PDF)
This form is required if your child has Diabetes. Please complete and sign this form annually and return it to the school office.

Administration of Oral Medication (PDF)
This form is required if your child's doctor has prescribed medication that your child is required to take during school hours. Please bring a copy of this form with you to your child's doctor appointments. 
Your doctor is required to complete and sign
 the middle section of the first page. Once you have completed the rest of the first page and signed in the four places on the second page, please return the form with your child's medication to the school office. We recommend that you ask the pharmacy to prepare two bottles of liquid medication, enough doses for school and the remainder to be kept at home. This form is also required if your child keeps Benadryl on other oral allergy medication in the school office for allergies. This form is required annually or per oral medication.

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