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Dublin City Schools

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Forms

Other Medical / Health Services Forms

2340 F5 Chaperone Emergency Medical Authorization Form

2340 F5 Chaperone Emergency Medical Authorization Form.pdf 160.54 KB (Last Modified on January 13, 2023)

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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)

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2340C F1a 6th Grade Outdoor Education District-Sponsored Overnight Trip Medical Permission Form

2340C F1a 6th Grade Outdoor Education District-Sponsored Overnight Trip Medical Permission Form.pdf 200.59 KB (Last Modified on January 13, 2023)

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2412 F1 Home Instruction Referral

2412 F1 Home Instruction Referral.pdf 150.68 KB (Last Modified on January 13, 2023)

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2412 F2 Home Instruction Physician Referral

2412 F2 Home Instruction Physician Referral.pdf 148.14 KB (Last Modified on January 13, 2023)

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5112 F2 Preschool Health Assessment Record

5112 F2 Preschool Health Assessment Record.pdf 153.29 KB (Last Modified on April 25, 2023)

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5310 F1 Student Health History Form-English

5310 F1 Student Health History Form-English.pdf 218.41 KB (Last Modified on June 14, 2023)

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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)

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5320 F4 Parent Varicella (Chicken Pox) Report Form

5320 F4 Parent Varicella - Chicken Pox Report Form.pdf 144.11 KB (Last Modified on June 14, 2023)

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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)

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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)

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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)

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