Cameron County School District

This form is used upon initial admission to the Cameron County School District. 

Every year this form should be updated and returned to the school nurse to assure we have current information on your child’s health status as well as the best way to reach you in the event of an illness or injury.

As part of the health services mandated by the Pennsylvania School Health Code 23.2, each student upon first entry, or in Grades K, 6, and 11 are required to have a physical examination performed by a physician. Student's are encouraged to see their family doctor for continuity of care and for a more complete physical. Any physical done by the student's family doctor within 1 year of the start of the school year will meet this requirement. The school doctor is also available to meet this requirement if a private physical is unable to be done. Have the student's family doctor complete the form below and return this to the nurse's office.

As part of the health services mandated by the Pennsylvania School Health Code 23.3, each student upon first entry, or in Grades K, 3, and 7 are required to have a dental examination. Student's are encouraged to see their family dentist for continuity of care, however the mobile dentist or the school dentist are available during school hours. The school dentist is only a screening and no cleaning/care will be preformed. Any dental care done by the student's family dentist within 1 year of the start of the school year will meet this requirement. Have the student's family dentist complete the form below and return this to the nurse's office.

In accordance with school policy, medication(s) should be given at home before and/or after school.  However, when this is not possible, prior to receiving the medication at school, each student must provide the school nurse with a Medication Administration Consent form signed by the student’s parent/guardian and a Medication Order from a licensed prescriber.  All medications must be in an original prescription bottle/container from a pharmacy. 

Individual Healthcare Plan to be completed by physician and signed by parent of student whose disability requires modification in provided school meals.

A new form must be completed each year starting May 1st for all students planning to participate in athletics. Sections 1 - 5 must be completed by the student's parent/guardian. Section 6 must be completed by a physician. Section 7 must be completed if a student participates in a second sport during the school year. Section 8 must be completed by a physician if an injury occurred during a sport. Section 9 will be completed during school if the student participates in wrestling.