General Forms and Documents

• Student Drop Off and Pick Up Procedures  (09/03/2020)
• Physical Education Uniform Order Form

Records and Transcripts

• Records Release Form for Current or Former LS/MS/US Students
• Transcript Request Form and Instructions

Transportation

• Transportation Intent Form

Student Health Forms

For students new to Providence Academy, the following health forms are required prior to starting the school year.

Pre-K

• Health Care Summary Form (physician signature required)
• Student Information Card
• Student Immunization Form
• Immunization Requirements

Kindergarten through 12

• PA Health Information Form
• Student Immunization Form
• Immunization Requirements

Medication At School

All medication must be kept in the health office during the school day. Students need a signed medication authorization form to receive medication from the health office. These forms are submitted yearly. Acetaminophen and ibuprofen may be given to students in grades 6-12 with a parent signature. All other medications, prescription or over-the-counter, require physician and parent signature. EpiPens and albuterol inhalers may be self carried when a medication authorization is on file. Albuterol inhalers for students in Lower School are kept in the health office.

• Authorization for Administration of Medication
• Authorization for MS-US OTC Medication

Asthma

Please submit an updated copy of your child’s Asthma Action Plan and the Asthma Individual Health Plan each year. Students in grades 6-12 who self carry their albuterol will need to complete the Student Inhaler Agreement. If your physician has not provided you with an Asthma Action Plan and your child may need albuterol or other medication for their asthma, please complete the medication authorization form.

• Asthma Individual Health Plan
• Inhaler Student Agreement

Food Allergies

Please submit an updated copy of your child’s Anaphylaxis Action Plan and Allergic Reaction Questionnaire each year.  If your physician’s office has their own version of the Anaphylaxis Action Plan, that is acceptable.

• Allergic Reaction Questionnaire
• Anaphylaxis Action Plan

Diabetes

Please submit an updated Treatment Authorization Form from you child’s physician each school year. A meeting with the school nurse will be arranged before the start of the year. In addition, parents will complete a new Diabetic Emergency Plan each year.

• Diabetic Emergency Plan

Seizures

Please submit an updated copy of your child’s Seizure Action Plan and Parent Questionnaire each year.

• Seizure Action Plan
• Questionnaire for Parent of a Student with Seizures

Flu Clinic

Information related to the Flu Clinic, and forms required before attending, may be found on the dedicated Flu Clinic page.