Preschool Medical Forms

The following forms are required to be completed by all students and turned in to the school nurse prior to a child attending school:

• Preschool Enrollment Information
• Preschool Health Information
• Any required medical plans and medication
  • Allergy Action Plan
  • Asthma Action Plan
  • Enteral Tube Feedings Form
  • Modified Diet Form
  • Parent Request Health Plan
  • Prescription Medication Form
  • Seizure Action Plan

The following form must be completed by a Medical Physician and returned within the first 30 days of preschool:

• Child’s Medical Statement - must be SIGNED and DATED by a physician
  • Not turning in this form within the first 30 days of preschool will result in your child being unable to attend preschool until it is turned in.  This is required by the state of Ohio.
• Immunization Records

The following forms must be completed and returned within the first 60 days of preschool:

• Child’s Dental Statement - must be SIGNED and DATED by a dentist.  
  • Parents may choose to deny dental services but must return the form stating “Parent Denial” and sign and date it.

All forms must be updated annually and must be in place before the child begins school. This helps ensure that all staff are aware of any health-related problems or emergency situations and that children are properly immunized.