Updating and completing the medical forms each school year is a task that often brings negative emotion, but Health Services wanted to find a way to make the process as easy and straight forward as possible.  Last school year was a big push moving towards a completely digital database for all medical documentation and records.  This year, we are requesting that all medical forms be submitted via the Form below, in entirety, prior to the school year starting. Please limit mailing, faxing or dropping off forms in person unless absolutely necessary.   If you must physically submit forms, please ensure they are complete and coordinate delivery with Mr. Phillips!

Submitting Forms

In the drop down menus below, you will find all the medical forms.  Some of these are required and some are not.  Please read each section and complete forms as necessary for your child.  Once the appropriate forms have been printed and completed by parent/guardian or physician, the forms can be scanned to a desktop or laptop, or you can simply take a picture of each form with your phone, and then attach all documents in the Google form below!  Please note: If you have multiple children, you will need to complete a submission form (below) for each student.

Form submission below:

SUBMIT MEDICAL FORMS - CLICK HERE!

Every student must submit an Emergency Card.  Please complete both sides of the Card.  There are places requiring signatures for both over the counter medications and potassium iodide (KI) in the event of a nuclear emergency, so please read over carefully.  You can learn more about potassium iodide (KI) in the bottom drop down menu.

Please click below to access form:

Emergency Card Form

These forms must be completed by a licensed healthcare provider: Physician (MD or DO), Clinical Nurse Specialist (APN), Advanced Practice Nurse (APN), or Physician’s Assistant (PA).

• If the student is enrolled in Preschool through 6th grade, please click below to access form:

Delaware Student Health Forms PS-6th

• If the student is enrolled in 7th or 8th grade, please click below to access form:

Delaware Student Health Forms 7th-8th

If your 6th, 7th, or 8th grader is participating on any of the after school sports teams, this form is required by the Delaware Interscholastic Athletic Association (DIAA), please click below to assess form:

2023-2024 DIAA Preparticipation Athletic Physical Forms

ALL Medications should be hand delivered to the Health Office by Parent or Guardian, and should not be sent in with students.

Medications are stored in the Health Office.  In order to give medications, there are a few forms that must be completed.  Headache/fever over the counter medications are covered under the Emergency Card, but all other medications must have the respective forms submitted for use. 

For non-prescription medications, please submit this form:

Non-Prescription Medication Form

For prescription medications, please submit this form: 

Prescription Medication Form

Please list any allergies your child has on the Delaware Student Health Form and Emergency Card.

If your child requires the use of auto-injectable epinephrine (Epipen, Auvi Q, etc) for his or her allergy, an Anaphylaxis Emergency Action Plan must be on file with the Health Center. Please ask your child's physician to provide this plan. Upon approval by the Health Office, epinephrine auto-injectors may also be stored in a classroom or with a teacher if necessary.  If that is needed, we do request a backup injector to be stored in the Health Office. 

Please click below to access form:

Anaphylaxis Emergency Care Plan Form

If your child has Asthma, please include an Asthma Action Plan when submitting your medical forms.  For students responsible enough to carry their own inhalers, a Self Carry Contract will also need to be submitted.  All inhalers and spacers will be stored in the Health Office, unless there is an approved need for a teacher or classroom to keep it on hand.  At this time, we are not allowing nebulizer treatments, but please reach out to Mr. Phillips if your child needs this option to see if accommodations are available.  

Please click below to access forms:

Asthma Action Plan Form

Asthma Self Carry Contract Form

Due to the variety of medical concerns or diagnoses that exist, the Health Office requests families to contact Mr. Phillips directly to discuss needs and/or accommodations necessary to care for your child if they have other medical considerations.   

The primary goal of our outdoor education areas is to provide an environment for children to engage in a variety of activities with as many risks mitigated by proper planning and training.  Spending time in wooded areas brings certain risks that cannot be completely eliminated, but several measures have been implemented to ensure our outdoor spaces are as safe as can be.  

All spaces are routinely manicured and monitored for signs of potential hazards.  The management of the trees surrounding our outdoor classrooms, outdoor equipment maintenance, removal of irritating/stinging plants (such as poison ivy, oak, and sumac), and pest management such as tick and mosquito control are a small part of our comprehensive campus safety plan.  

Our facility/grounds team works in conjunction with the State of Delaware, Department of Natural Resources, to make sure our property is managed and sprayed for mosquitos, stinging insects, and ticks.  In the drop down menu below, there is more information regarding how to best protect your child from these potential threats.

 Due to the difficulty of controlling ticks and mosquitos in large areas, personal protective measures are absolutely necessary when spending time outdoors.  While our campus is routinely sprayed and monitored for tick and mosquito populations, pesticides help discourage the pests rather than eliminate them.  Below you can find a simple list of protective measures to ensure your children are preventing bites and transmission potential for blood-borne illness.

1. Apply bug repellent daily before school.
2. Wear appropriate clothing.  Light colors make it easier to locate ticks.  Wear long sleeves, pants, and tall socks whenever possible.
3. Teach children to check themselves thoroughly after being outdoors, especially if playing in wooded or grassy areas.  Pay particular attention to hairline, in between toes, legs, and private areas. 
4. Bathe daily after being outdoors and check for insect bites, stings, or ticks.
5. Promptly and properly remove ticks from skin when found.
6. Report any incidence of tick bites to Mr. Phillips in order to help monitor your child for symptoms while at school. 
7. Educate children to not agitate stinging flying insects by swinging at them or trying to kill them, and quickly distance themselves when encountering one while alerting a faculty/staff member. 

Below is a diagram and description on properly removing a tick. 

• Remove ticks as soon as possible. 
• If ticks are attached, use tweezers to remove them (Figure below). Use tweezers to grasp ticks as close to an individual’s skin as possible, but do not get so close that you rip skin. The closer you are to the skin the less likely the tick’s head will be left in the skin during removal, as shown in the figure below.
• Ensuring that the head of the tick is removed with the tick’s body decreases the chances of obtaining a harmful pathogen or causing infection. It’s also difficult to identify a headless tick.
• Be careful to not scrape at the bite site as that could lead to a bacterial infection as well.
• Place the tick in a sealed bag or container in case symptoms develop and further testing is necessary.

Here are a couple resources regarding ticks, mosquitos, and preventive measures.

https://dnrec.alpha.delaware.gov/fish-wildlife/ticks/management/

https://dnrec.alpha.delaware.gov/fish-wildlife/mosquito-control/

https://extension.tennessee.edu/publications/Documents/PB1895.pdf

Skin cancer is the most common cancer in the United States.  It is also one of easiest preventable cancers if  measures are taken to protect the skin from the sun's ultraviolet radiation.  A substantial amount of UV exposure occurs before the age of 18, so incorporating sun safety education as early as possible is vital in preventing skin cancers occurring later in life. 

Listed below are a few steps to help protect your child from sun exposure while at school.

1. Apply sunscreen before the school day and provide extra for reapplication throughout the day.  We strongly recommend WIPES, as this eliminates problems with leaking bottles or overspray into sensitive areas.
2. Wear protective clothing outside whenever possible.  Long sleeves, pants, hats, sunglasses, or clothes with UV protection.
3. Limit exposure time in direct sunlight and utilize shaded areas for the majority of outdoor activities.
4. Educate your children on preventing skin cancer and the risks of sun exposure.
5. Be an advocate and model for your children by promoting sun safety!

Here are a few resources with more information on Sun Safety and Children!

https://www.sunsafetyforkids.org/index.html

https://www.cdc.gov/cancer/skin/pdf/sunsafety_v0908.pdf

https://www.cdc.gov/cancer/skin/what_cdc_is_doing/guidelines.htm

St. Anne's Episcopal School is located within the 10-Mile Emergency Planning Zone of the Nuclear power plant located in Salem, New Jersey.  In the unlikely event of an accident or incident at the plant, St. Anne's has developed an emergency plan with preparations for both evacuation and on-site sheltering in the case of a nuclear emergency.  

Health officials have declared that potassium iodide (chemical name KI), if taken in time and at the appropriate dosage, can protect the thyroid gland from radioactive iodine exposure during a nuclear emergency and reduces the risk of developing thyroid cancer as a result of that exposure. This finding has prompted the State of Delaware to supply all schools within a 10-mile radius of a nuclear reactor plant with supplies of KI tablets, together with instructions for their distribution in the event of a radiation threat or emergency. 

There is a signature spot on the Emergency Card for administering KI in the event of an emergency, so please make sure you complete that field when signing the medical forms.  

Below is a quick fact sheet regarding the use of KI in the event of a nuclear emergency. For additional information about KI, please contact your local pharmacist or healthcare provider.

Potassium Iodide (KI) Fact Sheet

There are twenty (20) schools in Delaware located within the ten-mile Emergency
Planning Zone (EPZ) of Salem/Hope Creek Nuclear Generating Stations (SHCNGS). Should
an emergency occur at SHCNGS, detailed radiological emergency plans will be implemented
to protect the health and safety of the people living and working in the affected areas.
Under certain conditions, a radioactive release from the nuclear power plant may
require the protective action of SHELTERING-IN-PLACE or RELOCATION or ingestion of
Potassium Iodide (KI). These protective actions would eliminate or reduce public exposure to
radioactivity.

Sheltering-in-place actions would have the school take shelter within specified areas of the building and await further instructions from the Delaware Emergency Management Agency (DEMA).

Evacuation actions would require students and faculty to leave school premises and transport all parties to our host school: Caesar Rodney High School, 239 Old North Rd, Camden DE 19934. 

• In the event of an evacuation, St. Anne's will be notified by the New Castle County Emergency Operations Center (NCCEOC) to prepare and evacuate the premises. 
• The school's Emergency Crisis Team will initiate evacuation procedures.  
• Families will be notified by the school that we have been instructed to evacuate campus.
• Students will not be allowed to be picked up from St. Anne's and must travel to the host school to be picked up once everyone has been accounted for.