Health Forms: Grades 1-4

The following forms are required before your child can attend school in the Lebanon Township School District:

1. Parent/Guardian Transfer/New Students Grades 1-4 Health Office Checklist

2. Universal Child Health Record

3. Immunization Record (complete by Medical Practitioner, or provide a copy of the child's record from their office)

   • Recommended immunizations

4. Elementary Health History Form

If your child has Asthma and/or an Allergy, the following forms are required to be completed before your child can attend school in the Lebanon Township school district:

1. Asthma Action Plan  (2 forms)

   • Form 1

   • Form 2

2. Allergy Action Plan

These forms are only required if your child needs medication during the school day:

1. Medication Authorization (2 forms)

   • Form 1

   • Form 2