New Student Health Forms
Your child’s health is important to us! The information that you provide in the Health Forms each school year is essential for helping the health care staff care for your child. In the event that your child would need medical attention by a physician, our healthcare providers would rely on this information to treat your child.
Before you begin the process of filling out the required Health Forms, please take some time to review the information on the Health Center section of the website pertaining to allergies, prescription medication, insurance and other important information.
Please complete the 2-step process for our health forms.
Step 1. By May 1, 2019: Answer the required questions via Google Health Form Questionnaire.
Step 2. By June 30, 2019: Download, print, and complete the required health forms.
The Health Forms must be completed on or after April 1, 2019 and a physical examination is required after June 30, 2018 according to the Delaware Interscholastic Athletic Association (DIAA). Please note that the DIAA requires the signature of the healthcare provider, student/athlete, and the parent/guardian. Even if the student is not participating in sports, you must still complete and sign the Delaware Interscholastic Athletic Association (DIAA) 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, 2019.
During the summer, while our Health Center is closed, a member of our health services staff will be in the office at least once a week to check messages and emails. If you have any questions or concerns, please feel free to contact us 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, and bring all (prescription and over-the-counter) medications your child has brought to school. Medications (prescription and over-the-counter) are NOT permitted on dorm unless approved by the Health Center.
St. Andrew’s Health Forms
- New Student Checklist for Submitting Health Forms
- Requirements for Health Forms
- Health Form Questionnaire (Google)
- Student Information & Medical Authorization Form (Page HCF-1)
- Health & Accident Insurance Enrollment Form (Page HCF-2)
- Insurance & Care Provider Information Form (Page HCF-3)
- Confidential Medical History Record Form (Page HCF-4)
- Tuberculosis (TB) Risk Assessment Questionnaire (Page HCF-5)
- 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)