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Medical-Travel-Release Forms
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MEDICAL-TRAVEL-RELEASE FORMS

Dear Parents,

To access the health forms for the new school year, please click on the link below. These confidential forms may be completed and sent electronically, or if you prefer, you may print them and fill them out by hand. Please take time to complete these forms and return them no later than August 1.

1) Emergency Medical Authorization Form

This form is used whenever a student has a health concern at school or travels off-campus. State law requires that each student have this form on file yearly. It is important that you include telephone numbers to contact you in an emergency. Also, please include names and telephone numbers of individual who can be contacted if you are unavailable. Consent for medical treatment covers only an emergency as determined by emergency medical services. It does not mean that you are consenting for routine care.

Failure to return this form would be viewed the same as refusal to consent for emergency treatment and your child will not be able to participate in any field trips or athletic activities.

2) Health History Form

This form should be completed for all new students. Returning students should use this form to report any change in medical condition or updated immunizations. Some students have special health needs that require accommodations in school or a plan in the event of an emergency. If your student has a known health condition, please contact the school nurse to discuss a plan in the case of an emergency. Medical information will be kept confidential at your request. As of the 2006 school year, all students in Ohio are required to have up-to-date immunizations documented to attend school. All students entering grades K-12 are required to have a second MMR vaccine. Students entering grades K-7 are required to have 3 doses of Hepatits B. For grades 8-12, Hep B is not required. Students entering K ONLY are required to have one varirella vaccine. Students will be excluded from school on the 15th day if immunization mandates are not met.

3) Authorization for Over-the-Counter Medications Form

Please complete this for any non-prescription medication to be administered at school. For all students, please consent for administration by the school nurse. For students entering grades 7-12, also consent for administration by the athletic trainer. Any other non-prescription medications not listed may be sent in to the school nurse in the original container with written instructions.

Prescription medications may also be administered on a daily or temporary basis at school. All prescription medications, including inhalers, must be accompanied by a signed authorization from the health care provider. Medications must be in the original container with a clearly marked label. Please contact the school nurse for the appropriate forms.

Screening for vision and hearing will be done for Pre-K, K, 1, 3, 5, 7, 9, and all new students as mandated by the state. If any problems are identified, parents will be notified. Students who wear corrective lenses should have them at school.

We ask you to please confirm that you are agreeing to conduct this exchange electronically.

I AGREE

Over the summer, parents of children entering grades K-12 should have received a green envelope that contained a secure account name and password to submit the online health forms via the Internet (parents of PreK students must submit a written copy signed by the child's physician).  These forms are required to begin any school activity, including sports team practices, and include an updated health history, travel release form, emergency medical release form, immunization record and over-the-counter medication authorization form.

I DISAGREE

If you click "I disagree" you will be directed to a printable copy of the Emergency Medical/Travel Authorization/Release and Health History Form.  Please mail the completed form to:

Beckie Hoagland
The Columbus Academy
4300 Cherry Bottom Road
Gahanna, OH 43230

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