- 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 235.68 KB (Last Modified on June 14, 2023) -
5335.01 F1 Parent-Guardian Information on Child's Life-Threatening Allergy
5335.01 F1 Parent-Guardian Information on Childs Life-Threatening Allergy.pdf 134.4 KB (Last Modified on September 5, 2023) -
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 115.08 KB (Last Modified on September 5, 2023)
Asthma Forms
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5335 F1 Parent-Guardian Information on Child's Asthma
5335 F1 Parent-Guardian Information on Childs Asthma.pdf 157.54 KB (Last Modified on September 5, 2023)
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 161.03 KB (Last Modified on June 14, 2023)
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 87.14 KB (Last Modified on June 14, 2023) -
5320 F5 Medical Provider Review and Determination of Parent Reported Varicella
5320 F5 Medical Provider Review and Determination of Parent Reported Varicella.pdf 133.74 KB (Last Modified on June 14, 2023) -
8330 F4a Parent Consent for Record Release Form-English
8330 F4a Parent Consent for Record Release Form-English.pdf 119.61 KB (Last Modified on June 29, 2021) -
8431 F2 Advisory of Pesticide Application in Classroom Buildings
8431 F2 Advisory of Pesticide Application in Classroom Buildings.pdf 79.77 KB (Last Modified on May 5, 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)