Administration Center for Education
507 Fishing Creek Road
P. O. Box 803
717-938-9577
717-938-2779 (fax)

Last updated: 10/23/17
Health Related Forms

For your convenience, below are various health related forms available for download.



Related Files

    pdf Application for Health Care Coverage (pdf file - n/a)

    PDF Parent Permission for fluoride to be given at school (PDF file - n/a)

    doc File medication permission form revised2.doc (doc file - 26 KB)

    pdf Private Dentist Report of Dental Exam of a School Aged Child (pdf file - n/a)

    pdf Medical Assistance and CHIP Insurance Application (pdf file - 552 KB)

    pdf School Physical Exam Form (pdf file - 195 KB)

    pdf Food Substitution for Special Dietary Needs (pdf file - 982 KB)

    pdf Medical Certificate for Immunization Deficits (pdf file - 239 KB)

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