General Forms & Documents 

Medical Forms

  • 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 7th grade. Current 6th 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.

Athletic Forms

  • 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.