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Health Services Forms for Parents and Guardians

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Caregiver Consent for Child COVID-19 Symptomatic Testing
Parent/Guardian Authorization of Another Adult for Administration of Medication
Parent/Guardian Opt-Out for BMI Reporting
Standard Authorization for the Exchange of Health Information
 

Caregiver Consent for Child COVID-19 Symptomatic Testing

The 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.

   

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.

 

Parent/Guardian Opt-Out for BMI Reporting

By 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 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.