Forms

Registration Forms for Region 16
(please contact your specific school for any additional forms you may need)

Core Registration Packet (K-12)

Additional Form for Kindergarten

Health Packet (PK-8)

Health Packet (9-12)

Immunization Religious Exemption Statute (as of 7/1/2015)

Medical Exemptions from Immunizations (12/2016)

Region 16 Health Guidelines and Policies

Health Assessment Form K-12 (2017-2018)

Health Assessment Form Birth-5yrs (2017-2018)

Release of Information Form

Medication Forms

The following forms pertain the administration of any and all perscription and non-prescription medications that students may use. These revised medication forms are for use starting with the school year 2011-12. In accordance with Connecticut State Statute (statute means law) 10-212a “Administration of Medication", there have been changes that must be followed in order for your school nurse to administer medication to your child.

Medication Administration Guidelines

Authorization for Administration of Medications by Self and/or School Personnel Form

Epi-Pen Administration form

Asthma Action Plan

Food Allergy Action Plan

Additional Forms

Working Papers

Long River Sports Physical

Field Trip Form

Fundraiser Form

(The above link includes the Region 16 fundraiser form and the requirements for complying with sections 10-215f and 10-221q of the Connecticut State Statutes.)

Beverages sold to students during the school day from any source must meet the Connecticut General Statute 10-221q “The Sale of Beverages sold to Students in all Public Schools.

Region 16 also participates in the Healthy Food Certification Program (HFC) with food exemptions, Connecticut General Statute Section 10-215f, which requires all food and beverage items sold to students during the school day from any source, including fundraisers, meet the nutrition guidelines set by the State Department of Education.

All fundraising events that offer food and/or beverages for sale to students and/or that students sell off premises require the District Fundraiser form. This form must be approved by the Principal, School Nutrition Director and Superintendent of Schools respectively. Fundraiser forms are available in each school office and on our website.

If you have any questions regarding this procedure or if you would like information regarding state-approved food items that may be sold to students during the school day or fundraisers, please contact Region 16’s District HFC contact person, Patricia Iraci at 203.758.6671.