Creating and maintaining a safe campus that supports the health and welfare of all members of the LJCDS community is of utmost importance.
The Health and Emergency Form is required for all students every year. Other required health forms for new students are listed below. Returning families can check requirements for physicals and immunizations based on grade level. If applicable, allergy and medication forms can be found in the links below.
Mandatory health forms must be completed and uploaded before students can attend classes and athletic practices if they start before the first day of school.
Health and Emergency Form
Required for all new students
Required for all returning students annually
Can be found in the Parent Portal (login required)
Referenced in case of emergencies when students are on and off campus
Collects health history, medication, emergency contacts and insurance information
Families can grant permission to administer these over-the-counter medications: acetaminophen (Tylenol); ibuprofen (Motrin or Advil); decongestant (Sudafed); antihistamines (Benadryl, Claritin, Zyrtec); Tums
If your child has an allergy or takes other over-the-counter medication or prescription medication, complete the appropriate forms found in the links based on grade level.
If there are changes at any time during the school year, contact School Nurse and Wellness Coordinator Jan Capon, RN, BSN, at firstname.lastname@example.org.
Required Health Forms
In addition to the Health and Emergency Form, all new students and some returning students may need to provide other required forms. To access the forms, click the links based on grade level and download the forms applicable to your child.
Once completed, upload the forms using the same link in the corresponding tab. The gray box allows you to browse or drag and drop files. The allergy and medication forms are only needed if applicable.
Returning families: If your child does not require a physical examination or immunization record this school year, but they have an allergy or need medication during the school day, please use the links based on their grade level to access, complete and upload the forms that apply to your child. These forms need to be submitted every year.
Allergy and Anaphylaxis Emergency Plan
Prescription Medication Administration Release Form
Authorization for Students to Carry a Prescription Inhaler, Epinephrine Auto-Injector, Insulin, Diabetic Supplies, or Other Approved Medication (only Grades 5–12)
Over-The-Counter Medication Administration Release Form
Please keep a copy of all forms for your records. The information submitted will be maintained by the LJCDS wellness team in the strictest of confidence and will provide the basic data essential to your child's care.
Health Form Links
Links for the 2023–2024 school year will be shared when the switch to the new system is complete.
Physical Evaluation and Health History Form
Required for all new students
Required for returning students entering Tiny Torreys, junior kindergarten, kindergarten, Grade 1 and Grades 7–12 (no physicals needed for returning Grades 2–6)
Physical exams must take place on or after May 1 and must be performed by a physician licensed in the United States.
Forms need to be uploaded by August 1.
For the Physical Evaluation and Health History form, the doctor must complete and sign the first page, and the parent/guardian and student must complete and sign the second page.
If your child’s physician is unable to see them in time to meet the due date, CVS Minute Clinics perform school/sports physicals for a nominal fee.
Students who have not uploaded the required physical evaluation forms will not be able to attend classes or athletic practices.
For Upper School students playing a fall sport, the required physical evaluation forms must be submitted by the start of the first athletic practice before the first day of school.
Proof of Immunizations
Required for all new students
Required for returning students entering Tiny Torreys, junior kindergarten, kindergarten and Grade 7
According to California law (SB 277), students are not allowed to attend school without showing proof of immunizations.
Students who have not uploaded the required immunization records will not be able to attend classes or athletic practices.
Students in Grades 5–12 who need to carry a prescription-labeled inhaler, epinephrine auto-injector, insulin and diabetic supplies, and/or other prescription medication with them must complete, sign and upload this form. Students must be instructed in the proper use of the medication and fully understand how to administer it.
It is preferable that a second prescription inhaler, epinephrine auto-injector, additional insulin and diabetic supplies or other prescribed medication be kept in the school in case the first is lost or left at home.
Both the student and the parent/guardian must sign and submit the form every year. The form can be found in the link based on the student’s grade.
Students are not allowed to carry medications of any kind without the written permission of the parent/guardian and school nurse.
Students taking prescription medications during school hours will need to have a Prescription Medication Administration Release Form filled out in its entirety prior to the start of school each school year. The form can be found in the link based on the student’s grade.
No medication will be allowed or given at school until this form is submitted, even if the medication was given at school the previous year. Prescription medications administered during school hours need to be:
In the original prescription container
In a Ziploc bag
Labeled with the student’s name, grade, parents'/guardians’ names, two emergency phone numbers and a current picture of the child
Be sure to take the prescription medication form to the physical as the form must be signed by your child’s physician.
All medications must be picked up by the end of the school year, or they will be discarded.
Over-the-counter medications not listed on the Health and Emergency Form require additional consent via the Over-the-Counter Medication Administration Release Form. Medications must be in the original container and in a bag properly labeled with the student’s name, grade, parents'/guardians’ names and emergency phone numbers.
It is at the discretion of the school nurse or designated health provider to administer any over-the-counter medications. It is best to give any medication at home prior to arrival at school. The first dose of any medication should never be given at school. All medications must be picked up by the end of the school year, or they will be discarded.