Form from: Saint Maximilian Kolbe Catholic School (540-1212-SK1)

Please read carefully through the following information regarding health services and medications.

1. PRESCRIPTION MEDICATIONS: All prescription medication given at school must be in the labeled original bottle from the pharmacy. Any prescription medication requires written permission from the parent to give the medication. 

Medications will not be given if the Prescription Drug and Medicine Authorizations form is not on file (one per medication). This form is available in the attachments or in the school office.

If a medication dosage changes or the medication is restarted, we will need a new written parental permission form signed. We will not give any medication unless these instructions are all in order.


- Asthma: Please make sure your student has an inhaler available for use at all times (even if the student has not needed an inhaler for a year). If you want your child to carry an inhaler on their person (as opposed to keeping in the health office) we will need that indicated on the Prescription Drug and Medicine Authorizations form. 

- Diabetes: If your child is diabetic, we need to know what type of insulin regime he/she is on and parent authorization. 

- Epi- Pen: If your child needs an Epi- Pen for allergic reactions, PLEASE send it to school on the first day. Check to ensure the medication has not expired.


2. OVER-THE-COUNTER MEDICATION: We do not keep any over-the-counter medications at school that are not provided by a parent for a specific child. *No homeopathic, natural or vitamin supplements are allowed at school, these should be given at home only.

If your child will need over-the-counter medication at school, it must be provided in the original container. No pills brought to school in plastic bags or unlabeled will be accepted. Medications will not be given if the Prescription Drug and Medicine Authorizations form is not on file (one per medication). This form is available in the attachments or in the school office.


3. IMMUNIZATIONS: It is your responsibility to provide immunization records to health services or scan and email them to the school. ALL STUDENTS must turn in proof of immunizations and be in compliance with MN School Immunization Law (MS 121A.15). This law states each student must have current immunization records on file at the school (Kindergarteners & 7th graders have additional requirements). If your student has had shots recently please provide updated documentation to the school office.


I have read and acknowledge the above Health Services Information.


Please sign below

signatureplease use your mouse or finger sign above


Your name

Your email