Health Forms

To ensure the health and safety of all students enrolled at Admiral Farragut Academy, an annual physical exam and clearance from a healthcare provider are required.  Physical exams on file may not be older than 12 months at any given point during the school year for a day or boarding student to participate in physical education, athletics, club, and other school activities on and off campus.  

Completed Health forms should be returned to the Health Center no later than August 7, 2023.

Forms may be returned via email to nurse@farragut.org (preferred), faxed to 727-344-1132 or hand delivered to Theresa Cail in the front office of DeSeta Hall.

The required annual Health forms are:

• • All new and returning K-12 students
    
  • • State of Florida School Health Exam (DH3040)
    • Health insurance information form
  • If you expect a change in insurance between now and the start of school, please wait to submit this form until changes have been made.
    

• • All new students and returning 7th-grade students
    
  • • Complete immunization record

Supplemental Health Forms to be completed if applicable:

• • If your child will need medication administered at school, please have the prescriber complete the:
    • Prescription Medication Authorization form
• • If your child has food, insect or other allergies requiring emergency medication such as diphenhydramine (Benadryl) and/or epinephrine (Epipen), please have your child’s health care provider complete and sign the
    • Allergy Action Plan
• • If your child has asthma requiring emergency medication such as an albuterol inhaler, please have your child’s health care provider complete and sign the
    • Asthma Action Plan

Athletic Forms Grades 6-12: If your child will be participating in athletics, please CLICK HERE for the instructions and required forms to be completed by a healthcare provider.

For students enrolled in SCUBA or Naval Science 1 (all 8th and new 9-12 students) or Naval Science 2, 3, or 4, the following additional forms are required:

• • Scuba Diver Medical Clearance form
  • Naval Science Standard Release and Health Risk Screening

As an FYI, the following Health forms along with some other non-health school forms will be sent to you via email and should be electronically completed, signed and submitted. Please complete and submit electronically when received.

• • Consent to Treat
  • Authorization for Over-the-Counter medications

Please feel free to contact me with any questions or concerns.

Suzanne Douglass, RN, BSN

Director of Health Services 

Admiral Farragut Academy

nurse@farragut.org

727-384-5506