Medical Forms

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Medical Forms

Athletic Physical Form

Permission for Medicine at School

Permission for Medicine at School Form (Word format)

Permission for Medicine at School

Permission for Medicine at School Form (pdf format)

Permission for Self-Administration of Medication

Permission for Self-Administration of Medication Form (pdf format)

Permission for Self-Administration of Medication

Permission for Self-Administration of Medication Form (Word format)

Immunizations 09-10

• Diphtheria, Tetanus, Pertussis (DTaP): five doses required. Four doses acceptable if dose 4 given on or after 4th birthday. Booster dose of Tdap required at age 11.
• Poliomyelitis (IPV/OPV): four doses required. Three doses acceptable if dose 3 given on or after the 4th birthday.
• Measles, Mumps, Rubella: two doses required.
• Hepatitis B: three doses required through grade 9.*
• Varicella (chickenpox): two doses required for Kindergarten; one dose required grades 1-9* unless history of varicella disease documented by a licensed physician. Two doses are currently recommended by ACIP for all ages.
• Haemophilus influenzae type b (Hib): three doses required for children less than 5 years of age in preschool or childcare operated by a school.
• Pneumococcal conjugate (PCV7): four doses required for children less than 5 years of age in preschool or childcare operated by a school.
• Hepatitis A: two doses required for children less than 5 years of age in preschool or childcare operated by a school.
* ALL students will be required to have 3 doses of Hepatitis B and 2 doses of varicella for the 2010-2011 school year.

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In order for children to receive medicine while at school, the forms (at left) must be appropriately filled out and returned to the school prior to its administration. Each request expires at the end of the current school year.