Health and Safety Forms

Below is a list of required forms for common illnesses. In most cases, these forms must be completed by a physician. Please submit them to the school nurse as soon as possible.

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ASTHMA
Action Plan - Asthma
Medication - Authorization

 

BEE STING ALLERGIES
Action Plan - Bee Stings
Medication - Authorization

 

CONCUSSION
Concussion Protocol

DIABETES
Action Plan - Diabetes
Medication - Authorization

EPILEPSY/SEIZURES
Action Plan - Seizures
Medication - Authorization

FOOD ALLERGIES
Action Plan - Food Allergies
Medication - Authorization

LATEX ALLERGY
ACTION Plan - Latex Allergy
Medication - Authorization

LICE
Lice Guidelines & Re-Entry Form

OVER THE COUNTER MEDICATION
Medication - Authorization (to be completed by the parent/guardian)

PRESCRIPTION MEDICATION
Medication - Authorization

SICKLE CELL
Action Plan - Sickle Cell
Medication - Authorization

OTHER
NC Health Assessment Form - Submit this form when enrolling your child at DCA.
Athletic Physical Evaluation - Submit this form when applying to be in the Middle School Athletic Program.
Medication Authorization Release Form (MAR) - Submit this form when using a non-DCA Medication Authorization Form.