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EVSC Good Schools Getting Better

Health Services




Health Services Forms

The following forms and information are for the 2009 - 10 school year.


Immunization Quick Reference for 2009-2010
Are your immunizations up-to-date?
Medication Administration Permission Form
Parents: print out form, complete and sign, for medicines student needs to take while at school
Asthma Care Plan
Form to be completed by MD for your student with asthma
Diabetes Care Plan
Form to be completed by MD for your student with diabetes
Food Allergy Guidelines and Care Plan
Forms requiring parent input and MD input for your student with food allergies
Seizure Care Plan
Form to be completed by MD for your student with a seizure disorder
Student Physical Exam Form
Exam form for MD to complete for all new students to EVSC, all incoming students in K, 6, & 9 grades
Past Health History
Health History form for parent to complete
IHSAA Athletic Physical
Required for participation in High School Athletics
PE Restricted Activity Form
For MD to complete to restrict Physical Education Plan

Evansville Vanderburgh School Corporation
1 S.E. Ninth Street | Evansville, Indiana 47708 | 812-435-8453






©2009 Evansville Vanderburgh School Corp. All rights reserved.