All School Forms

All School Forms

Below you will find documents needed to allow students to participate in events and general forms for the convenience of parents. Some forms can be completed online while others require you to print and submit as noted. For questions call the main line 763-258-2500 or send an email to



2019-2020 LS Student Supply List

After School

After School Activities Registration

2019-2020 Lower School Extended Day Information


Spring Break Opportunities

Check back for 2020 Spring Break Camp

Summer Reading

Please see each grade level’s Summer Reading lists below:


First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Summer and Advanced Programs

US Required Summer Reading

US Summer Math Review

Selected Summer Enrichment Programs

Academic Disciplinary Guidelines

CAP Academic Forfeiture

Academic Ineligibility

College Opportunities

Check back


Check back


Student Health Forms

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

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

Kindergarten through 12
PA Health Information Form
Emergency Contact 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


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


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


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

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