Student Health Forms
Sports Physical Forms
Students participating in district athletic programs must have a completed sports physical on file each school year before they may try out for or practice a sport. The physical must be completed and signed by a California-licensed physician or nurse practitioner.
The required sports physical forms include a Health History Form, Physical Examination Form, and Medical Eligibility Form. To protect student privacy, only the completed Medical Eligibility Form should be submitted to the school's front office for the site athletic director. The Health History Form and Physical Examination Form are for use by the family and healthcare provider and should not be submitted to the school district.
Access the sports physical forms to view and download all required documents.
Food Allergies
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- Spanish
The 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
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
Medication Permission Form
The student’s doctor fills out the "Medication Permission 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
The 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.
