Health Services Forms for Parents and Guardians

Non-In-Person Learning Application/COVID-19 Health Eligibility Form

Students with health concerns related to COVID-19 - whether a contraindication to COVID-19 vaccination (conditions that increase the risk for a serious adverse reaction) or a health condition that places the student at greater risk of severe illness from COVID-19 as outlined by the Centers for Disease Control (CDC) - and who have supporting medical documentation via the COVID-19 Health Eligibility Form are eligible for non-in-person learning for 2021-22.

To apply for non-in-person learning, parents/guardians should:

1. Complete the initial application form
2. Call or meet with your child's healthcare provider so they can complete and submit the COVID-19 Health Eligibility Form

All required documentation must be submitted by August 26, 2021. Applications submitted after this deadline (for example, if a student has a newly developed medical condition) will be considered on a case-by-case basis.

All applications will be reviewed by an ICSD-appointed committee of healthcare professionals.

Parent/Guardian Authorization of Another Adult for Administration of Medication

Through this form, parents/guardians can authorize another adult (such as a friend, family member, or household member) to administer certain medications to their child. 

• Download the Parent/Guardian Authorization of Another Adult for Administration of Medication Form

Standard Authorization for the Exchange of Health Information

This form authorizes the exchange of protected health information (PHI) and education records (including personally identifiable information obtained therefrom) between your child’s health care provider and authorized school officials.

• Download the Standard Authorization for the Exchange of Health Information Form