Forms/Health Room Information

General Forms

Student Accident Insurance Cover Letter

Roman Catholic Diocese of Harrisburg Voluntary Form

Family Trip Form 

Guest Permission Form

Service commitment Form

Health Room Information

 

The Pennsylvania School Health Law requires all children to have a physical exam:

  • Upon Original entry into school

  • Pre-K and Kindergarten

  • 6th grade

  • 11th grade

The Pennsylvania School Health Law requires all children to have a dental exam:

  • Upon Original entry into school

  • Pre-K and Kindergarten

  • 3rd grade

  • 7th grade

*Only physical and exams obtained within the twelve (12) months prior to the required school year will be accepted.

 

Immunization Records must be submitted at the time of enrollment. Please see the School Vaccination Requirements form below.

Please fill out the forms below for all prescription and non-prescription medication.

  • All medication must be brought in by a parent and be accompanied by a doctor’s order.

Contact Mary Gruber, L.P.N with any questions. mgruber@lebanoncatholicschool.org or 717.273.3731, ext 303

Submit all forms to Milissa Woodward, Enrollment Coordinator
mwoodward@lebanoncatholicschool.org

 

 

 

Health Room Forms

Student Health Information

Physical Examination Form

Dental Examination Form

Dental Exam Preference

Asthma Action Plan

Food Allergy & Anaphylaxis Emergency Care Plan

School Vaccination Requirements

Prescription Medication Form

Non-Prescription Medication Form