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Health Forms & Documents
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BMI opt out letter for 2023 ...
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If you do not wish to have your child’s weight status group information included as part of the Health Department’s survey this coming school year, please print and sign the BMI opt out 2023-2024 School Year form.
Health Forms Packet
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A complete packet of all the forms below.
Required New York State Health...
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This official NYS Health Appraisal Form is required for physical examinations; please print this form for your doctor to use. If your child has had a physical in the past 12 months, please send a copy or have your doctor fax a copy.
Health Forms Memo
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Print this sheet and refer to it as you select other forms to print, complete and return. This memo also lists contact information for the Health Office, including telephone, fax and email.
Emergency Health Record & Medical Release Form
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Every student must have a Student Emergency Health Record form on file in the Health Office. Your healthcare provider will require the Release Form to share Protected Medical Information with the school district.
Authorization to Administer Medication
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If you wish for medication to be administered to your child during the school day, this Authorization Form must be printed, completed (by both parent AND physician) and returned to the Health Office.
Dental Health Certificate w Return Notice
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New York State law recommends that school districts request a dental certificate for each newly enrolled student. Print this sample Dental Health Certificate and forward it to your child's dentist for completion. The completed certificate should be returned to the Health Office.
Hand Santizer Form
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Print, complete and return this form to the Health Office ONLY if you do NOT wish your child to use Alcohol-Based Hand Sanitizers while at school.
Student Health History
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The Student Health History Form is required for any new student enrolling at Chautauqua Lake Central School. Print, complete and return this form to the Health Office.
Life Threatening Health Conditions Notice
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Important information for the parent/guardian of any child who has a life-threatening health condition, including a known allergy, that will put the child in danger of death during the school day if a medication or treatment order is not in place.