Walk-Thru Registration » Health Forms

Health Forms

The files below contain the most commonly used health forms for school. Please print the forms you need, complete and sign forms and turn them in to the Hart health office. Forms must be updated and re-submitted at the start of each school year.
 
Contract to Carry Life-Sustaining Medications on Campus
This form must be filled out and signed by a parent and/or guardian, the student and the prescribing physician. The completed form is needed if your child needs any form of prescription medication while at school, such as an inhaler, EpiPen, glucagon, insulin or other prescribed medications.
 
Food Allergy Action Plan
This form must be completed and signed by a parent and/or guardian and the child's physician. This form includes detailed information regarding your child's allergy, including symptoms, dosage of medication needed to offset an allergic reaction and emergency phone numbers. 
 
Insurance Parent Letter
Read this information regarding low-cost insurance coverage options that can help families without coverage or with charges not covered by their current insurance plans.  Pleas note if your child is hurt or injured during school activities, you are responsible for your child's medical bills.
 
Prescription or Over-the-Counter Medication Consent Form
This form must be completed and signed by a parent and/or guardian and the child's physician. The completed form is needed if your child needs to take any prescription or over-the-counter medications while on campus.

Inhalers on Campus
Students who carry inhalers must submit the contract to carry life-sustaining meds on campus form (see below) in order to carry their inhalers on campus.
 
Healthcare Coverage
The Healthcare Options form below, printed in both English and Spanish, lets families know about optional healthcare coverage they may purchase based on California law.