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Form must be completed in one sitting.

Medical Expectations

Medication will NOT be dispensed at school unless:
  1. Medication is in a prescription box
  2. With the student's name on it
  3. Along with documentation from the doctors office.
  4. Along with a completed medication authorization form. (You can obtain a copy from the school or our school website under the resources tab.) 
  5. No asthma medication (albuterol, flovent, etc) will be dispensed without a current asthma action plan on file in addition to above requirements. 

HLA Medical Form

Gender
Medical History (Check all that apply) Required
Upload JPEG or PNG
Upload JPEG or PNG file (Max 15MB)
Does your child have any allergies?
Does your child recieve medication at school?
Upload JPEG or PNG
Upload JPEG or PNG file (Max 15MB)

2800 Linwood Blvd.  Kansas City, MO 64128

HOPE LEADERSHIP ACADEMY

816-921-1213

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