Student Medical Forms & Documents

Exam & Immunization Forms

• Health Questionnaire
• Physical/Dental Exam Form (physicals from last 12 months)
• CHIRP Release Form
• Immunizations for Incoming 6th Graders
• Current Immunization Records (the link lists requirements & ages). Your child may not receive immunizations every year at their checkup. If they do, we need an updated record, please. Typically your child's doctor can fax these to the school at 574-233-7290. Please be sure that the dates for each immunization are on the record.

 

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For children who need to take medication at school

-Please review the School Day Medication Policy & Procedures.
-Before we can administer any OTC medication to students, a Parent Consent Form is required.
-Before we can administer any prescription medications, including inhalers, to students, both a Parent Consent Form & a Physician Consent Form (signed by the physician) are required.
-Medication to be administered must be delivered to the school office by a parent in the original packaging, labeled with the student's name. The school does not keep a stock of medication to administer to children. Children may not carry medications on themselves into the school building.
 

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For children with allergies & asthma

• Bee Sting & Allergic Reactions Form
• Food Allergy & Anaphylaxis Emergency Care Plan
• Inhaler Consent
• Asthma Action Plan for Home & School
• Epi Pen Consent
• Nebulizer Consent

 

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Vision & Hearing Screening

• Vision and Hearing Screening 

 

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For children who are unable to be immunized

• Objection to Immunization Form