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

-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.
 

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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