Health Services Forms
Renton School District requires that families provide medication, treatment orders and equipment at least ONE WEEK before school begins to ensure that your child is allowed to begin school on the first day of school.
If you believe that your child no longer has a life threatening condition, provide a written note from your child’s healthcare provider at least ONE WEEK before school starts stating that your child no longer has a life threatening condition.
WAC 392.380.020 defines a life threatening condition as “a health condition that will put the child in danger of death during the school day if a medication or treatment order and nursing plan are not in place.” Examples include life threatening allergies, diabetes and some cases of asthma and seizures.
Medication Administration Forms
- Allergy/Epinephrine Medication Authorization Form and Care Plan
- Asthma/Inhaler Medication Authorization Form and Care Plan
- Diabetes Medication Orders
- Insulin Pump Orders
- Authorization Form for Other Medication
- Authorization Form for Other Medication (Spanish)
- Certificate of Immunization Status - A Certificate of Immunization Status (CIS) is the form that Washington State requires parents/guardians to complete for each student. CIS's are available in English, Chinese, Korean, Russian, Spanish, Tagalog and Vietnamese.
- Certificate of Exemption - If a parent/guardian wants to exempt a student from receiving immunizations, a Certificate of Exemption (COE) must be completed by the parent/guardian and healthcare provider. COEs in English, Chinese, Korean, Russian, Somali, Spanish, Tagalog and Vietnamese are available. Please note that the King County Public Health may exclude students who are not fully compliant with immunizations in the event of a disease outbreak.