Health Services Forms for Parents and Guardians
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Caregiver Consent for Child COVID-19 Symptomatic TestingThe Ithaca City School District offers symptomatic testing for students who become unwell at school. Student participation in the testing program is voluntary, and the Ithaca City School District is requesting that parents/caregivers complete a consent form to allow their children to be tested for COVID-19 at school. We will not test your child without your consent. |
Ithaca High School Field Trip Medical FormA parent must complete and sign this form for all trips beyond the school day hours and/or beyond Tompkins County AND submit it to the school nurse two weeks before the trip. |
Parent/Guardian Authorization of Another Adult for Administration of MedicationThrough this form, parents/guardians can authorize another adult (such as a friend, family member, or household member) to administer certain medications to their child. |
Parent/Guardian Opt-Out for BMI ReportingBy completing this form, parents/guardians can opt out of having their children's weight status information included in the 2022-2023 School Survey by the New York State Department of Health. |
Standard Authorization for the Exchange of Health InformationThis 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. |