Est. 1949 | South Bend, Indiana
Student Medical Forms & Documents
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Important Documents for all Parents to Review
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Forms for Returning Students
Please complete and return these forms with your back to school paperwork.
For all returning students- Health questionnaire
- Physical Exam Form (physicals from last 12 months)
- Dental Exam Form (exam from last 12 months)
- Current Immunization Records (link lists requirements & ages)
- Your child may not receive immunizations every year at their checkup. If they do, we need an updated record.
- 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.
For children who need to take medication at school- Medication Consent Form (physician completes)
- Medication Consent Form (parent completes)
For children with allergies & asthma
For children who are unable to be immunized -
Forms for New Students
Please complete and return these forms with your registration information.
For all new students- Health questionnaire
- Physical Exam Form (physicals from last 12 months)
- Dental Exam Form (exam from last 12 months)
- CHIRP Release Form
- Current Immunization Records (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.
For children who need to take medication at school- Medication Consent Form (physician completes)
- Medication Consent Form (parent completes)
For children with allergies & asthma
For children who are unable to be immunized