OLG Annual Health Information Form

OLG Annual Health Information Form

2026-2027 School Year
This form is REQUIRED yearly for the health office.

This form is for K-8 students, not for preschoolers. Preschool has a separate set of required documents.

You must fill out this form for each of your children.

You can find health office information on the school website.

Immunization record: ONLY for new transfer students, all kindergarteners, and all 7th graders. Please scan and email a clear copy of your child's immunization record to schoolnurse@olgschool.net. We do not have a fax machine.

This is confidential information that is only shared with the health office and appropriate school personnel.
Student Information
Student First Name
Student Last Name
Birthdate

MonthDayYear
Gender
2026-2027 Grade Level
Preferred Hospital
(for emergency)
Allergies
Does your child have any allergies and/or intolerances?
If yes, check all allergies/intolerances that apply:

Other
Please describe your child's allergies/intolerance.
Medical Conditions
Does your child have any health conditions?
Please check all health conditions that apply:

Other
Please describe your child's health conditions.
Medications: Routine and Emergency
Does your child require routine medication at school?
The health office will reach out to you to collect the required documents for medication administration at school.

MEDICATION ADMINISTRATION AND AUTHORIZATION FORM
Does your child require emergency medication at school?
The health office will reach out to you to collect the required documents for emergency medication administration at school.

For students with anaphylatic allergies, asthma, seizures, and diabetes, a emergency action plan from your child's physician is required.

For students who have been authorized by a licensed provider and a parent/guardian to self-carry a medication, a contract for student self-carry medication is required.

CONTRACT FOR STUDENT SELF-CARRY MEDICATION
Additional Information
Do you have any additional information to share with the health office regarding your child's physical and/or mental health? If so, please describe.
Parent/Guardian Information
Name of Parent/Guardian One

First NameLast Name
Parent/Guardian One Email Address
example@example.com
Parent/Guardian One Cell Phone Number

Area CodePhone Number
Parent/Guardian One Relation
Would you like the submission confirmation of this form to go to another parent/guardian?
Parent/Guardian Two Name (optional for confirmation)

First NameLast Name
Parent/Guardian Two Email Address (for confirmation)
example@example.com
Parent/Guardian Two Relation
I understand that if I have a new student, a kindergarten student, or a 7th grade student, I must send a clear scan of my child's immunization record to schoolnurse@olgschool.net.
Parent/Guardian Authorization
I understand that the information provided on this form will be shared with appropriate school personnel as needed to support my child's health and safety while at school. I understand it is my responsibility to notify the school health office of any changes in my child's health status during the school year.
Upon submission of this form, you will receive an email confirmation at the email address(es) provided above. If you do not receive an email confirmation, your form did not go through and needs to be completed again.
Should be Empty:

OLG Annual Health Information Form

Student Information

Allergies

Medical Conditions

Medications: Routine and Emergency

Additional Information

Parent/Guardian Information

Parent/Guardian Authorization