Contacts

School Nurse and Wellness Coordinator
Jan Capon, RN, BSN
jcapon@ljcds.org

Head Athletic Trainer
Christine Mitchell
cmitchell@ljcds.org

Director of Early Childhood Center
Maria Curtis 
mcurtis@ljcds.org

Health Forms

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.

Health Form Links

The 2023–2024 Health Forms can be accessed through the Parent Portal (login required). Once logged in to the portal, click “Health Forms” in the Resources tab to access the forms. Contact techsupport@ljcds.org with any questions.

Annual Form

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 jcapon@ljcds.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. All forms can be found in the Parent Portal. 
 
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 has an allergy or needs medication during the school day, please 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.

Physical Examinations

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

Immunization Record

  • Required for all new students
  • Required for returning students entering Tiny Torreys, junior kindergarten, kindergarten and Grade 7 
 

Only if Applicable

List of 4 frequently asked questions.

  • Allergy and Anaphylaxis Emergency Plan

    Students who have a mild to severe allergy and anaphylaxis will fill out this form every year.

  • Authorization for Students to Carry a Prescription Inhaler, Epinephrine Auto-Injector, Insulin, Diabetic Supplies, or Other Approved Medication (only Grades 5–12)

    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.

  • Prescription Medication Administration Release Form

    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 Medication Administration Release Form

    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. 

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9490 Genesee Avenue
La Jolla, CA 92037
858-453-3440

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