Forms

General Forms & Documents

Next Year . . .

LCA Health Questionnaire and Physical Form
Tdap Booster and MCV4 Letter and Form
The Ohio Department of Health requires a dose of Td or Tdap AND a Meningococcal (MCV4) Vaccine to be administered before a student enters 7^th grade. Current 6^th graders will need to show proof of having received this booster dose before returning to school in the fall.
Medication Consent Form
This form permits the administration of medicine to the student by the school nurse.
Allergy Action Plan
Should your child have food or other allergies, this form allows your physician to permit the administration of 1 or more allergy medications to your child during school hours.
Asthma Action Plan
This two page form includes an asthma action plan and a form that will allow your child to carry and use an inhaler during school hours. Some parents choose to keep a back-up inhaler with the nurse in the school clinic. This form also allows the nurse to provide the inhaler to the child.
Seizure Action Plan
This two page form outlines a child’s seizure emergency and treatment protocol, and provides guidance to school staff members on how to respond should the child experience a seizure during school.

CYO Physical Form
This form is required to be completed prior to participation in any practice or game. The form is good for 1 year— if you submit a form completed by your child’s doctor prior to the start of a school year, the form should be valid for the entire sports year.
Emergency Medical Form
CYO Coaching Application Form
This form must be completed by all coaching candidates.