Kenneth N. Butz Jr. Elementary School

The following forms can be printed and brought to your child's dentist/doctor if needed. 

• Allergy Action Plan
• Asthma Action Plan
• Authorization to Release/Furnish Information Form
• Diabetic Plan of Care
• Dietary Restrictions
  
  • Dietary Restrictions Information
  • Dietary Restrictions Form
• Hypo & Hyperglycemia Symptom Sheet
• Medical Authorization Form
• Private Dental Exam Form
• Private Physician Physical Form
• Seizure Plan of Care
• Student Health Information Update Form

• Kindergarten Student Health Information Packet