Medical Forms

A registered nurse in available on campus during school hours on regular school days.

(Tip: Copy all medical forms before you submit them.)
Forms for all students due by first day of school, 08/19/20

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), 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 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 7-10 and 12 only - Meningitis information form (required for all Gr 7-10 and all Gr 12)

Class Trips (Gr 6)

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

K-12 Authorization for Emergency Response

Authorization for Emergency Response

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 7-10 and 12 only - Meningitis information form (required for all Gr 7-10 and all Gr 12)

Class Trips (Gr 7-8)

Gr 6-8 Acknowledgement of Medication Policies for Overnight Trips
Gr 8 – Washington, D.C. - Fall 2019

Gr 7-8 STU Health Form for International Travel
Gr 8 –Mexico Mission Trip (if participating) – due October 2019

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

Grades 9-12

School Forms (Gr K-12)

K-12 Authorization for Emergency Response

Authorization for Emergency Response

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 7-10 and 12 only - Meningitis information form (required for all Gr 7-10 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)

Either:

Print a pre-completed version directly from
or
Print a blank PDF version

2020-2021

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)

K-12 Authorization for Emergency Response

Authorization for Emergency Response

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 7-10 and 12 only - Meningitis information form (required for all Gr 7-10 and all Gr 12)

Class Trips (Gr 6)

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

K-12 Authorization for Emergency Response

Authorization for Emergency Response

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 7-10 and 12 only - Meningitis information form (required for all Gr 7-10 and all Gr 12)

Class Trips (Gr 7-8)

Gr 6-8 Acknowledgement of Medication Policies for Overnight Trips
Gr 8 – Washington, D.C. - Fall 2019

Gr 7-8 STU Health Form for International Travel
Gr 8 –Mexico Mission Trip (if participating) – due October 2019

Athletics Medical Forms (Gr 7-12)

Either:

Print a pre-completed version directly from
or
Print a blank PDF version

Grades 9-12

School Forms (Gr K-12)

K-12 Authorization for Emergency Response

Authorization for Emergency Response

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 7-10 and 12 only - Meningitis information form (required for all Gr 7-10 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)

Either:

Print a pre-completed version directly from
or
Print a blank PDF version

Medical Forms

CHCA Extension (513) 247-9944

Scan and send encrypted Email

Fax

Postal Mail

CHCA Extension
(513) 247-9944