Medical Forms

Return forms to the nurse's office in the building where this child will attend
	CHCA Extension (513) 247-9944	Scan and send encrypted Email	Fax	Postal Mail
EBL Elementary School Building (PK2 - Grade 3)	x 109	EBLNurse@chca-oh.org	(513) 247-0125	11312 Snider Road 45249
Founders' Campus Building	x 209	FCNurse@chca-oh.org	(513) 247-9362	11300 Snider Road 45249
MSL High School Building	x 309	MSLNurse@chca-oh.org	(513) 247-0982	11525 Snider Road 45249
Armleder School Building	x 428	ASNurse@chca-oh.org	(513) 721-3300	140 West 9th Street 45202

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), FARE Emergency Care Plan (as needed)

PK-12 Seizure Action Plan (as needed)

PK only Immunization Requirements Info

School Forms (Gr K-12)

K-12 Authorization for Emergency Response

×

Authorization for Emergency Response

Families of students enrolled in CHCA by 07/31 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 08/01 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 & return), FARE 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 7-12 only - Meningitis information form (required for all Gr 7 and Gr 12)

Gr 7-12 only - Health Records File Sheet (required for international students only)

Class Trips (Gr 6)

Gr 6-8 Acknowledgement of Medication Policies for Overnight Trips
Gr 6 – PVM Camp - Earliest Fall 2020

Athletics Medical Forms (Gr K-6)

Medical information is collected online during registration.

Grades 7-8

School Forms (Gr K-12)

K-12 Authorization for Emergency Response

×

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 & return), FARE 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 7-12 only - Meningitis information form (required for all Gr 7 and Gr 12)

Gr 7-12 only - Health Records File Sheet (required for international students only)

Class Trips (Gr 7-8)

Gr 6-8 Acknowledgement of Medication Policies for Overnight Trips
Gr 8 – Washington, D.C. - Earliest Spring 2021

Gr 7-8 STU Health Form for International Travel
Gr 8 –Mexico Mission Trip (if participating) – Earliest Spring 2021

Athletics Medical Forms (Gr 7-12)

Return the OHSAA Physical Examination and OHSAA Medical Eligibility forms to (1) athletics@chca-oh.org, (2) the black box outside the MSL Campus gym, or (3) 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

New in 01/21: OHSAA Medical Authorization to Return to Play After COVID-19 Infection

Grades 9-12

School Forms (Gr K-12)

K-12 Authorization for Emergency Response

×

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 & return), FARE 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 7-12 only - Meningitis information form (required for all Gr 7 and Gr 12)

Gr 7-12 only - Health Records File Sheet (required for international students only)

Class Trips (Gr 9-12)

MayTerm 2021 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 OHSAA Physical Examination and OHSAA Medical Eligibility forms to (1) athletics@chca-oh.org, (2) the black box outside the MSL Campus gym, or (3) 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

New in 01/21: OHSAA Medical Authorization to Return to Play After COVID-19 Infection

Directory

In This Section

News & Calendar

News & Calendar

Upcoming Events

CHCA Extension
(513) 247-9944

Scan and send encrypted Email

Fax

Postal Mail

Medical Forms Required

2020-2021

Grade PK

School Forms (Grade PK)

Authorization for Emergency Response

Grades K-6

School Forms (Gr K-12)

Authorization for Emergency Response

Class Trips (Gr 6)

Gr 6-8 Acknowledgement of Medication Policies for Overnight Trips Instructions

Athletics Medical Forms (Gr K-6)

Grades 7-8

School Forms (Gr K-12)

Authorization for Emergency Response

Class Trips (Gr 7-8)

Gr 6-8 Acknowledgement of Medication Policies for Overnight Trips Instructions

Athletics Medical Forms (Gr 7-12)

Grades 9-12

School Forms (Gr K-12)

Authorization for Emergency Response

Class Trips (Gr 9-12)

Athletics Medical Forms (Gr 7-12)

Medical Forms

CHCA Extension (513) 247-9944

Scan and send encrypted Email

Fax

Postal Mail

CHCA Extension
(513) 247-9944