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Requested Forms

Medication Consent Form

Authorization for administration of prescriptive or over-the-counter medication.

NYS Physical Exam Form

Required NYS school health examination form. To be completed by a private health care provider or school medical director.

Application for Employment Certification (AT-17)

Consent for Health Information Release

Authorization for use or disclosure of health information. This information will be used to provide a safe and healthful environment and develop an appropriate program for your student at school. 

Dental Health Certificate

New York State law (Chapter 281) permits schools to request a dental examination in the following grades: school entry, K, 2, 4, 7 and 10. 

Physical Fitness Certification

Physical Fitness Certification for employment. 

Medical Exemption for Immunizations Form

Medical exemption statement for children 0-18 years of age. Please note: this exemption form applies only to immunizations required for school attendance. 

BMI Status Opt Out Form

As part of a required health examination, a student is weighed and his/her height is measured. These numbers are used to figure out the student's body mass index or 'BMI'. If you'd like to opt your child out of this part of the health examination, please click the form below.

If you have any other questions or would like to see another form added to this list please call your child's Nurse Office.