Health Forms
Sports Physicals
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Sports Physical Form
Sports Physical Form- SpanishThe student’s doctor fills out this form on a yearly basis for students participating in district offered sports. It is submitted in the school front office for the site athletic director. The form must be submitted before a student can try-out for or practice any sport. It must be signed by a California licensed medical doctor or nurse practitioner.
Food Allergies
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Food Allergy Notification Form
This is a Food Service form documenting food allergies or sensitivities. It is only needed if the student will be eating the hot lunch offered by the district. The student’s doctor fills out this form on a yearly basis and it is submitted in the District Office for Food Service.
Food Allergy Action Plan
Food Allergy Action Plan- SpanishThe student’s doctor fills out this form on a yearly basis if the student needs Epinephrine at school in case of an anaphylactic reaction to food. Parents also sign the form. Submit in the school front office for the site school nurse.
**LVJUSD does not serve any items with peanuts or tree nuts. However, we do bring in products that may be produced in facilities that handle and process nuts, so we cannot guarantee that meals are completely free of traces of nuts, or nut residue.
General Health
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Student Health History Form
Student Health History Form- Spanish
(These forms are fillable PDFs that can be completed online, saved, and sent electronically.)Parents/guardians fill out this form for students new to the district (all grades) and incoming TK and Kindergarten students. Please submit with proof of immunizations when registering student at the school front office or the Kindergarten registration fair in February. Submit only once unless the student has a significant change in health.
Medications
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Medication Permission Form
Medication Permission Form- SpanishThe student’s doctor fills out this form on a yearly basis if the student needs medication (prescription and/or over-the-counter) during school hours. Parents/guardians also sign the form. Submit the form together with the medication (in its original container, with a pharmacy label if prescription) in the school front office for the site school nurse.
Self-administered Medication Contract Form
Self-administered Medication Contract Form- SpanishThe student’s doctor fills out this form on a yearly basis if the student needs to carry on his/her person an emergency medication (ie inhaler, epinephrine) during school hours. Parents/guardians and students also sign the form. Submit in the school front office for the site school nurse.
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