- Roxbury Public Schools
- Forms
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All forms can be downloaded or viewed with Adobe Acrobat Reader. District forms apply to all schools and each school may have additional forms they require.
District Wide Forms
Medical
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Anaphylaxis Action Plan
District-wide form for students suffering from allergies
Action-Plan-for-Anaphylaxis--v20190314-1119--20200529--20200728-1355.pdf 335.84 KB (Last Modified on July 9, 2021) -
Asthma Action Plan
District wide form for students suffering from asthma
Asthma-Treatment-Plan-STUDENT--v201705-20200529-2014--20200728-1355.pdf 1.64 MB (Last Modified on July 9, 2021) -
Health Forms
Health forms for New students Gr. Pk thru Gr. 6 (Health History Form; Universal Child Health Record)
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Medical Alert - Measles Vaccination
Letter that informs parents when students would be excluded from school due to not being adequately vaccinated. (2/2015)
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Medication Permission
Permission slip for medication to be administered to students in school by the school physician, a certified or non-certified school nurse, a substitute school nurse employed by the district or the student's parent/guardian.
For students K-6, in addition to an action plan submitted (for Anaphylaxis, Asthma, and/or Seizures), please also include the "Permission for Administration of Medication in School Form" for all medications on file in the health office.
Permission_for_Administration_of_Medication_in_School_-_v20190127.pdf 191.53 KB (Last Modified on July 9, 2021) -
Seizure Action Plan
District wide form for students suffering from seizures
Seizure-Action-Plan-Packet--v20200529-2014--20200728-1355.pdf 1.15 MB (Last Modified on July 9, 2021) -
Self-Administered Medication
Permission slip for self-administration of medication for a potentially life-threatening illness.
For students 7-12, in addition to an action plan submitted (for Anaphylaxis, Asthma, and/or Seizures), please also include the "Permission for Self-Administration of Medication in School" for all inhalers and epipens. If unable to self-carry, please reach out to your building nurse. Note: Students who participate in school sports and clubs will need to be able to self-administer their emergency medication.
Permission_for_Self_Adminstration_of_Medicine_-_v20200313.pdf 46.35 KB (Last Modified on July 9, 2021)
Registration
Other
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Media Consent Form
Parent Consent Form for Release of Student's Personal Information and/or Student's Written Work/Artwork for Press Release or on the School District's Websites
School Specific Forms
Elementary Schools
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2022-2023 Chromebook Insurance Form (SPANISH)
2022-2023 Formulario de seguro de Chromebook (español)
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Acceptable Use Policy for students in Grades 5 & 6
Acceptable Use Policy Agreement to use the Internet and District Network Resources
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Acceptable Use Policy for students in Grades K-4
Acceptable Use Policy Agreement to use the Internet and District Network Resources
Middle School
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2022-2023 Chromebook Insurance Form (SPANISH)
2022-2023 Formulario de seguro de Chromebook (español)
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Acceptable Use Policy for students in grades 7-12
Acceptable Use Policy Agreement to use the Internet and District Network Resources
High School
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2022-2023 Chromebook Insurance Form (SPANISH)
2022-2023 Formulario de seguro de Chromebook (español)
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Acceptable Use Policy for students in grades 7-12
Acceptable Use Policy Agreement to use the Internet and District Network Resources
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RHS Alternate Transportation for Athletes
Transportation form for Alternate Transportation to and from Athletic Event
Free/Reduced Lunch Application
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Made available electronically through the Genesis parent portal under FORMS. Click for more information.