Our district Nurse, Jennifer Shultz, supports the health programs at each of our school sites. This means creating health plans for our students with medical needs, performing vision and hearing screenings, performing staff training for medical needs of students, and more. In addition, every school site has at least one full-time health clerk, who is trained to support students with their school-based health needs.
Meet our Team:
Jennifer Shultz, MSN, RN, SNSC
District Nurse
619-825-5639
The following forms are for your reference, these are provided to families each school year, as well
as when needed to meet annual requirements. If you have any questions, please reach out to
your student's site Health Clerk. Thank you.
For All Students:
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Rev. Date
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California Immunization Requirements for TK-12th Grade: *All state immunization requirements must be met in order for child to start school*
For parents and staff reference to know requirements for school entry. English/ Spanish
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5/24
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CDPH When to Keep Your Child Home from School or Child Care: For parents and staff to reference to know when to keep a student home from school based on symptoms. English/ Spanish
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9/2023
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Type 1 Diabetes Information for Parents- English/ Spanish
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5/28/25
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Type 2 Diabetes Information for Parents- English/ Spanish
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5/28/25
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Additional Forms for PK:
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Rev. Date
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California Immunization Requirements for Pre-Kindergarten: *All state immunization requirements must be met in order for child to start school*
For parents and staff reference to know requirements for school entry. English/ Spanish
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5/24
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Additional Forms for TK/K:
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Parents of TK and Kinder Students please see forms below for state requirements.
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Rev. Date
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KOHA Parent Letter- English/ Spanish
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5/28/25
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Kindergarten Oral Health Assessment Form- English/ Spanish
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7/22
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Waiver of the KOHA Requirement Form- English/ Spanish
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7/22
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Commonly Used Medication Forms:
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Forms below need to be completed by your child's physician in order to have medication on campus.
Medication are valid for one calendar year.
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Rev. Date
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Parent Agreement of Medication at School: This form must be completed by the parent/guardian and attached to a valid physician order for students to have medication at school. See below for appropriate form for physician orders. English/ Spanish
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5/29/25
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Asthma Medication Order and Emergency Care Plan- English
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4/22
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Allergy and Anaphylaxis Emergency Care Plan- English
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4/18
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Diabetes School Management Plan & Insulin Orders- Obtain these forms from your child's Endocrinologist.
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Seizure Action Plan (SAP)- Obtain these forms from your child's Neurologist.
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Authorization for Medication at School- English
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5/29/25
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