School Forms, Summer Reading, and Supply Lists
Admissions Forms - please print, fill out, and return to SA
Athletics Forms - please print, fill out, and return to SA
Concussion Information Sheet
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*PARENTS/STUDENTS: Please read, sign and keep a copy. You must turn in a signed copy prior to the start of practice.
VHSL Athletic Physical Form
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*All Student Athletes MUST submit a new VHSL Physical Examination Form, effective May 1st – June 30th of each school year.
ParentsWeb Instructions
Pre-K School Forms - please print, fill out, and return to SA
Student Medical Forms
It is very important to maintain a student’s current contact information at all times in the school clinic should an emergency arise. These forms include important emergency instructions, contact information, and medical data provided by the students’ parents or legal guardians and primary care physician. All required school forms can be printed from the school website or requested from the school’s clinic/front office. Parents/Legal Guardians are required to submit completed school medical forms as specified by the students grade level or enrollment status by the first day of school. These forms are as follows:
Newly Enrolled Students and Kindergarten:
- Student Medical Information (Students will not be administered medication without a completed form).
- HIPAA (Health Insurance Portability and Accountability Act) Compliant Authorization
- Permission for Health Screening/Discussions
- Copy of current immunizations OR Religious Exemption Affidavit
- Copy of a physician health physical. Virginia requires this form to be completed no longer than one year before entry to Kindergarten.
Forms required for students who are NOT newly enrolled, but are entering grades 3rd, 6th, or 9th OR if you need to update your student’s health status:
- Student Medical Information
- HIPAA Compliant Authorization
- Permission for Health Screening/Discussions
- Copy of current immunizations OR Religious Exemption Affidavit
- Authorization for the Administration of Medication by School Personnel Form (Complete only for students who need the nurse to administer prescription or a non-prescription medication not provided by the school).
Required every school year for ALL students:
- HIPAA Compliant Form
- Permission for Health Screening/Discussions (Student will not participate unless form is completed with specific appropriate response and a parent’s signature).
- Authorization for the Administration of Medication by School Personnel (Complete only for students who need the nurse to administer prescription or a non-prescription medication not provided by the school).
- VA Asthma Action Plan (This form must be completed by a physician each school year if your child has been diagnosed with asthma)
Student Medical Information Form
Pre-K
*School requires a new form per student each year.
HIPAA Compliant Authorization
Pre-K
Authorization for the Administration of Medication by School Personnel
Pre-K
*Only fill out for students who need the nurse to administer a regular prescription.
VA Asthma Action Plan
Pre-K
Commonwealth of virginia school entrance health form
pre-k
Clinic Wish List
Pre-k
Extended Care Registration and Information Form (TBD for 21-22)
Pre-K
*Complete only if your family requires after-school care.
Information and Emergency Form
Pre-K
*School requires a new form per student each year.
Media COnsent Release Form
Pre-K
Waiver of Liability COVID 19
Pre-K
Request for Bus Service
Pre-K
*Complete only if your family requires BUS SERVICE.
school messenger contact form and instructions
Pre-K
k-12 School Forms - please print, fill out, and return to SA
Student Medical Forms
It is very important to maintain a student’s current contact information at all times in the school clinic should an emergency arise. These forms include important emergency instructions, contact information, and medical data provided by the students’ parents or legal guardians and primary care physician. All required school forms can be printed from the school website or requested from the school’s clinic/front office. Parents/Legal Guardians are required to submit completed school medical forms as specified by the students grade level or enrollment status by the first day of school. These forms are as follows:
Newly Enrolled Students and Kindergarten:
- Student Medical Information (Students will not be administered medication without a completed form).
- HIPAA (Health Insurance Portability and Accountability Act) Compliant Authorization
- Permission for Health Screening/Discussions
- Copy of current immunizations OR Religious Exemption Affidavit
- Copy of a physician health physical. Virginia requires this form to be completed no longer than one year before entry to Kindergarten.
Forms required for students who are NOT newly enrolled, but are entering grades 3rd, 6th, or 9th OR if you need to update your student’s health status:
- Student Medical Information
- HIPAA Compliant Authorization
- Permission for Health Screening/Discussions
- Copy of current immunizations OR Religious Exemption Affidavit
- Authorization for the Administration of Medication by School Personnel Form (Complete only for students who need the nurse to administer prescription or a non-prescription medication not provided by the school).
Required every school year for ALL students:
- HIPAA Compliant Form
- Permission for Health Screening/Discussions (Student will not participate unless form is completed with specific appropriate response and a parent’s signature).
- Authorization for the Administration of Medication by School Personnel (Complete only for students who need the nurse to administer prescription or a non-prescription medication not provided by the school).
- VA Asthma Action Plan (This form must be completed by a physician each school year if your child has been diagnosed with asthma)
Student Medical Information Form
K-grade 12
*School requires a new form per student each year.
HIpaa compliant authorization
K-Grade 12
Permission Form for Health Screening/discussions
K-Grade 12
*SA requires a signed form for each student, each year
Authorization for the Administration of Medication by School Personnel
K-Grade 12
*Complete only for students who need the nurse to administer a regular prescription
VA Asthma Action Plan
K-Grade 12
Commonwealth of virginia school entrance health form
K-Grade 12
*required for all students entering kindergarten
Clinic Wish List
K-Grade 12
Extended Care Registration and Information Form (TBD for 21-22)
K-Grade 6
*Complete only if your family requires after-school care.
Google Apps for education acceptable use policy
K-Grade 12
*SA requires a signed form for each student
Media COnsent Release Form
K-Grade 12
Waiver of Liability COVID 19
K-Grade 12
Request for Bus Service
K-Grade 12
*Complete only if your family requires BUS SERVICE
Parents may check their student's grades by logging into