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Nancy Triozzi » Links to Medical Forms

Links to Medical Forms

On this page you will find links to medical forms you may need if your child has severe allergies, asthma, seizures, diabetes, or requires medication to be given at school. Please remember all forms and signatures must be filled out completely.

FOR EACH NEW SCHOOL YEAR, THE EARLIEST THE DATE CAN BE IS JULY 1.  For example, medical forms for the 2023-2024 school year must be dated after July 1, 2023
This link will take you to an allergy action plan provided by FARE (Food Allergy Research & Education, a form with a waiver of liability for a delegate, and a self-administration form.
The FARE form is the form accepted for anaphylaxis protocol and autoinjectable epinephrine by the district.
If your child requires a delegate to administer epinephrine, the delegate waiver form must be filled out. If you bring in your child's medication without the proper forms, the medication will be sent back home.
If your child has peanut or tree-nut allergies they will automatically be placed at the allergy table or nut-free table on the first day of school.  They can remain here throughout their days in the Marlboro Township Public School district or you can opt out.  In order to opt out, your child's physician can right a letter claiming STUDENT CAN/MAY SIT AT A REGULAR LUNCH TABLE and either SCHOOL YEAR 2020-2021 or K-8.  The doctor must sign it. 
Yearly a RELEASE AND HOLD HARMLESS AGREEMENT must be filled out by either two parents in a two parent household or one parent.  The signatures must be witnessed.  Please remember that a witness's signature must have the same date as the signer.  When these forms are incorrect they are sent back until completed correctly.
This form provides important asthma treatment information to school medical personnel so that an appropriate individualized health care plan is in place during the time the affected student is in the school environment. Please remember signatures by both parent and physician are required in the appropriate places.
These forms provide important seizure treatment information to school medical personnel so that an individualized health care plan can remain in place for your child if the need occurs within the school environment.
This form grants permission to the appropriate school personnel to administer medication to a student during school hours. Please remember, medications MUST be brought in by a parent. Medication can be given to the staff in the main office. They must be in their original containers and have the child's full name and teacher on them. Please do not send in expired medication. Any medication brought in without the appropriate paperwork will be returned until completed.