Medical Forms

This form is for ALL prescription medications as well as Over-the-Counter medications that either exceed the recommended dosage on the label and/or need to be given more than THREE times during the school year.
Authorization of Epi-pen, Inhaler, and/or Glucagon. In addition, this form can also be used for those students who have Type I Diabetes and need access to their glucose meter at all times. To be completed by parent / guardian AND physician.
This form is to be completed by all parents who request an immunization exemption for their child based on medical, religious or philosophical objections. Please remember that in the event of an outbreak of a particular illness that is covered by a vaccine (an outbreak may be defined as only one case), your child will be excluded from school until the outbreak has been cleared by the health department unless you decide to have your child immunized at that point.
This form is available to families who have students with asthma. Please email the completed form to your school nurse.
We are also adding the self-carry agreement form which must be completed by student, parent and school nurse when a student carries those emergency medications.
This form is available to families who have students with food allergies. Please email the completed form to your school nurse.
Detailed description of information for parents, staff and students in order to safeguard our children at school who have significant food allergies.
In the event that your child has a seizure at school, please complete the following care plan so that we can provide the best possible care for your child. In addition, the second link is for additional information to determine your child's health
© 2022. Bellbrook-Sugarcreek Schools. All Rights Reserved.