Skip To Main Content

Clinic Forms

Notes from your School Nurse

COVID: YCSD Updated Return to School Guidelines

Updated School Physical Form 2021

2021 - 2022 VA Dept. of Health Immunization Schedule and Requirements

Food Allergy Letter Beginning of the Year

This letter is a summary of requirements

Food Allergy Beginning of the Year Letter Page 2

Food Allergy Action Plan

THis form must be completed by their physician annually.  Parents, please fill out your portion with all phone numbers and signature.

Special Dietary Needs Form for Children with Food Allergies

Must be completed annually by their PCP.

Lactose Intolerance form

Must be completed annually by their PCP.

Medication Administration Form - Required for each medication

Please print this form in "Landscape" orientation.

Asthma - Beginning of the Year Information

Provides what is needed if your child has Asthma

Beginning of the Year Asthma Letter for Returning Students

Asthma Action Plan

Permission For Student To Carry Their Own Inhaler form 

Seizure Action Plan

Diabetes - Blank Daily Carb Count Sheet

This is a tool that can be used by parents of a Diabetic student.  Provides information to the nurse of the carb count in their packed lunch.

Religious Exemption

Tdap Information Letter - 7th grade requirement

Note Change:  The Tdap is now required for 7th grade entry and not 6th grade.  However, if your child has received the Tdap vaccine, please provide an updated copy to their school nurse.