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Arlington Public Schools


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 Arlington Public Schools
Health Services

For more information contact Shirley Holck, RN, at 478-4121, Ext. 160 or email shirley.holck@apseagles.org.



Caretaker authorization for administration of prescription medication to student

                                                          Physician's request for administration of prescription mediations by school personnel

Physical Examination Form

Student Self-Management of Asthma, Anaphylaxis

Asthma or anaphylaxis medical management plan

Diabetes medical management plan for student self-management of health condition

Refusal of Immunization for Medical Reasons Form

Refusal of Immunization for Religious Reasons Form

Questionnaire for Parent of a Student with Seizures

Seizure action plan

Emergency Seizure Medication Consent Form