Medical Forms
(Tip: Copy all medical forms before you submit them.)
Forms for all students due by first day of school, 08/21/19
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Return forms to the nurse's office in the building where this child will attend
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Scan and send encrypted Email |
Fax |
Postal Mail |
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EBL Elementary School Building |
EBLNurse@chca-oh.org | (513) 247-0125 | 11312 Snider Road 45249 |
| Founders' Campus Building | FCNurse@chca-oh.org | (513) 247-9362 | 11300 Snider Road 45249 |
| MSL High School Building | MSLNurse@chca-oh.org | (513) 247-0982 | 11525 Snider Road 45249 |
| Armleder School Building | ASNurse@chca-oh.org | (513) 721-3300 | 140 West 9th Street 45202 |
Medical Forms Required
2019-2020
Grade PK
School Forms (Grade PK)
PK only Authorization for Emergency Response (electronic)
PK only Medical History (required)
PK only Medication Perm (OTC & Rx Meds) (optional)
PK-12 Asthma Information Sheet (as needed)
PK-12 Severe Allergy Policy, Letter (sign & return), Emergency Care Plan (as needed)
PK-12 Seizure Action Plan (as needed)
PK only Immunization Requirements Info
Grades K-6
School Forms (Gr K-12)
×
Authorization for Emergency Response
Families of students enrolled in CHCA by July 31 receive a secure, personalized link via eMail to provide their Information Update online, which automatically generates the Authorization for Emergency Response and delivers it to the nurse in your child’s building.
If you are enrolling August 1 or later, we welcome you! You will receive a PDF version of this form from your building nurse or your admissions counselor.
Please email your building nurse with any questions.
K-12 Medication Permission (OTC & Rx Meds) (optional)
K-12 Immunization Requirements info
PK-12 Asthma Information Sheet (as needed)
PK-12 Severe Allergy Policy, Letter (sign and return), Emergency Care Plan (as needed)
PK-12 Seizure Action Plan (as needed)
Gr 7-12 only - Tdap information form (required all Gr 7 and new Gr 8-12)
Gr 7-9 and 12 only - Meningitis information form (required for all Gr 7-9 and all Gr 12)
Class Trips (Gr 6)
Gr 6-8 STU Health Form for Domestic Overnight Trip
Gr 6 – PVM Camp - Fall 2019
Athletics Medical Forms (Gr K-6)
Medical information is collected online during registration.
Grades 7-8
School Forms (Gr K-12)
×
Authorization for Emergency Response
Families of students enrolled in CHCA by July 31 receive a secure, personalized link via eMail to provide their Information Update online, which automatically generates the Authorization for Emergency Response and delivers it to the nurse in your child’s building.
If you are enrolling August 1 or later, we welcome you! You will receive a PDF version of this form from your building nurse or your admissions counselor.
Please email your building nurse with any questions.
K-12 Medication Permission (OTC & Rx Meds) (optional)
K-12 Immunization Requirements info
PK-12 Asthma Information Sheet (as needed)
PK-12 Severe Allergy Policy, Letter (sign and return), Emergency Care Plan (as needed)
PK-12 Seizure Action Plan (as needed)
Gr 7-12 only - Tdap information form (required all Gr 7 and new Gr 8-12)
Gr 7-9 and 12 only - Meningitis information form (required for all Gr 7-9 and all Gr 12)
Class Trips (Gr 7-8)
Gr 6-8 STU Health Form for Domestic Overnight Trip
Gr 8 – Washington, D.C. - Fall 2018
Gr 7-8 STU Health Form for International Travel
Gr 8 –Mexico Mission Trip (if participating) – due October 2018
Athletics Medical Forms (Gr 7-12)
Return the paper OHSAA Physical pages 3 & 4 to the Athletic Office located by the gym in the building where your student will attend classes. These require a doctor signature.
Either:
- Print a pre-completed version directly from
or - Print a blank PDF version
Grades 9-12
School Forms (Gr K-12)
×
Authorization for Emergency Response
Families of students enrolled in CHCA by July 31 receive a secure, personalized link via eMail to provide their Information Update online, which automatically generates the Authorization for Emergency Response and delivers it to the nurse in your child’s building.
If you are enrolling August 1 or later, we welcome you! You will receive a PDF version of this form from your building nurse or your admissions counselor.
Please email your building nurse with any questions.
K-12 Medication Permission (OTC & Rx Meds) (optional)
K-12 Immunization Requirements info
PK-12 Asthma Information Sheet (as needed)
PK-12 Severe Allergy Policy, Letter (sign and return), Emergency Care Plan (as needed)
PK-12 Seizure Action Plan (as needed)
Gr 7-12 only - Tdap information form (required all Gr 7 and new Gr 8-12)
Gr 7-9 and 12 only - Meningitis information form (required for all Gr 7-9 and all Gr 12)
Class Trips (Gr 9-12)
JTerm 2020 forms - see course instructor for due date
Gr 9-12 STU Health Form for International Travel (required )
Gr 9-12 STU Self Medication Agreement (required only if student needs medication while off campus)
Athletics Medical Forms (Gr 7-12)
Return the paper OHSAA Physical pages 3 & 4 to the Athletic Office located by the gym in the building where your student will attend classes. These require a doctor signature.
Either:
- Print a pre-completed version directly from or
- Print a blank PDF version