- Dublin City Schools
- Medical / Health Services Forms
Medication Forms
Allergy Forms
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5330A E F1 Allergy and Anaphylaxis Emergency Orders and Action Plan
5330A E F1 Allergy and Anaphylaxis Emergency Orders and Action Plan.pdf 169.36 KB (Last Modified on May 6, 2020) -
5335.01 F1 Parent-Guardian Information on Child's Life-Threatening Allergy
5335.01 F1 Parent-Guardian Information on Childs Life-Threatening Allergy.pdf 124.3 KB (Last Modified on April 30, 2020) -
8500 F1 Medical Statement for Special Diet Accommodations
8500 F1 Medical Statement for Special Diet Accommodations.pdf 172.22 KB (Last Modified on September 17, 2021)
Assisted Feeding Forms
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5335.02 F7 Parent Agreement for Gastrostomy-G Tube Reinsertion
5335.02 F7 Parent Agreement for Gastrostomy-G Tube Reinsertion.pdf 76.95 KB (Last Modified on May 5, 2020)
Asthma Forms
Catheter Forms
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5330 C F1 Request for Clean Intermittent Catheterization by School Personnel
5330 C F1 Request for Clean Intermittent Catheterization by School Personnel.pdf 129.08 KB (Last Modified on April 30, 2020)
COVID Related Forms
Immunization Forms
Private Provider Forms
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3120.091 F3 Liability Release for Private Providers
3120.091 F3 Liability Release for Private Providers.pdf 133.31 KB (Last Modified on January 27, 2023)
Seizure Care Forms
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5340 F5 Parent-Guardian Information on Child's Seizure Disorder
5340 F5 Parent-Guardian Information on Childs Seizure Disorder.pdf 175.24 KB (Last Modified on May 5, 2020)
TB Forms
Other Medical / Health Services Forms
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2340 F5 Chaperone Emergency Medical Authorization Form
2340 F5 Chaperone Emergency Medical Authorization Form.pdf 160.54 KB (Last Modified on January 13, 2023) -
2340C F1 District-Sponsored Overnight Trip Medical Authorization Form
2340C F1 District-Sponsored Overnight Trip Medical Authorization Form.pdf 216.7 KB (Last Modified on January 13, 2023) -
5310 F3 School Vision and-or Hearing Screening-Monitoring Waiver
5310 F3 School Vision and-or Hearing Screening-Monitoring Waiver.pdf 612.71 KB (Last Modified on August 27, 2020)
Arabic Forms
Chinese Forms
Japanese Forms
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8330 F4a Parent Consent for Record Release Form-Japanese
8330 F4a Parent Consent for Record Release Form-Japanese.pdf 149.34 KB (Last Modified on June 29, 2021)