New Student Health Forms
Your child's health is important to us! The information you provide in our health forms each school year is essential for helping the Health Center staff care for your child. In the event that your child needs medical attention from a physician, our medical providers rely on this information to treat your child. Your child's health information will be kept confidential at all times and used only by School personnel or healthcare providers on a need-to-know basis during the school year.
Before you begin the process of filling out our required health forms, please take some time to review the information we've provided here concerning allergies, prescription medication, insurance, and other important student health information.
We appreciate your time and efforts as you carefully and legibly complete all of the required health forms. These forms are listed and can be downloaded individually below. You can also download all the forms in a single packet here.
In order to attend St. Andrew's School for the 2017-18 school year, ALL students are required to have a physical examination after April 1, 2017. Please note that some of our health forms require a signature from a physician as well as the student and parent or guardian.
In order for student-athletes to be eligible to participate in sports, the Delaware Interscholastic Athletic Association (DIAA) also requires certain forms.
Please take a few minutes to review the checklist before submitting your health forms to us via email, fax, postal mail, or courier. Please email your forms to firstname.lastname@example.org, fax your forms to 302-378-8512, or mail your forms to Health Center, St. Andrew's School, 350 Noxontown Road, Middletown, DE, 19709.
All forms for NEW students are due by June 30, 2017.
If you have any questions regarding the forms, please contact the Health Center at 302-285-4240 or email@example.com.
We look forward to seeing you on Opening Day in Founders Hall. Please be sure to check in with us to verify that your child’s health forms are complete, as well as to turn in (and discuss) any medications your child is taking.
St. Andrew's Health Forms
- New Student Checklist for Submitting Health Forms
- Requirements for Health Forms
- Student Information & Medical Authorization Form (Page HCF-1)
- Health & Accident Insurance Form (Page HCF-2)
- Insurance & Care Provider Information Form (Page HCF-3)
- Flu & Potassium Iodide Form (Page HCF-4)
- Prescription & Over-the-Counter Medication Form (Page HCF-5)
- Confidential Medical History Record Form (Page HCF-6 & HCF-7)
- Tuberculosis (TB) Risk Assessment Questionnaire (Page HCF-8)
- Anaphylaxis Emergency Care Plan (only for students who have severe allergies or allergic reactions)
- Asthma Action Plan (only for students who have asthma)
- Seizure Action Plan (only for students who have seizures)
Delaware Interscholastic Athletic Association (DIAA) Forms & Disclosures
- Guidelines for Students Participating in Athletics
- DIAA Permission Form (Page DIAA-1)
- DIAA Pre-Participation Physical Evaluation History (Page DIAA-2)
- DIAA Pre-Participation Physical Evaluation Examination (Page DIAA-3)
- DIAA School Athlete Medical Form (Page DIAA-4)
- DIAA Guidelines for Protecting Your Athletic Eligibility (Page DIAA-5)