Our Forms

2021 - 2022 School Year

A full set of forms is required on your child's first day of school and DC Universal Health and Oral Health will need to be updated if they expire during the school year.

 

These six forms are required for every child:

Please check the box that allows your child play outside the fenced area so that your class may take a nature walk around the block.

This form requires the signature of your doctor and "Date of Health Exam" must be August 1, 2020 or later. It will need to be updated if it expires during the school year.

 

This form is required for children age 3 and older on Sept. 1

This form requires the signature of your dentist and "Date of Exam" must be August 1, 2020 or later. This form will need to be updated if it expires or becomes applicable during the school year.

This form is only required for students who require medication or treatment at school.

This form requires the signature of your doctor. If we do not have this form on file, it is assumed your child does not require any medicine or treatment while at school.

This form is only required for students with a diagnosed allergy.

This form requires the signature of your doctor. If we do not have this form on file, it is assumed your child is allergy free and requires no special care.

Please submit your completed forms as pdf files

through your Parent Portal

* Please Note:

The DC Universal Health Certificate contains a section regarding risk assessment for tuberculosis (TB). Many children do not require the Tuberculin Skin Test (TST) for TB.

 

Your doctor should conduct a tuberculosis exposure risk assessment first, and only administer the TST if indicated in accordance with American Association of Pediatrics Guidelines. If your child does not need a TST, the doctor may simply check the low risk box and initial the form there, in addition to signing at the bottom.