General Forms & Documents
- 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.
- 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.