Health Forms and Documents
Each of the following forms are PDF documents.
Health and Wellness
An “Emergency Health Information Form” is sent home to parents in late August/early September. Parents are required to provide emergency contact information, which may include friends or relatives to be called in case of illness or injury if the parents cannot be reached. This form gives the school written permission to call the emergency contact(s) listed, as necessary. It is important to inform the school in writing of changes to contact information. If you cannot be contacted, the school may not release your child to anyone other than the person or persons listed in case of emergency.
Parents are also required to provide updated health information on Page 2, (the reverse side). This includes allergies, medications, (both prescription and over-the-counter medications), and recent health information. This health information is kept on file by the nurses only.
New York State Education Department Guidelines state that ALL medications, including over-the-counter medications, given at school, require the following:
• A written order from your child’s physician stating the name of the medication, dosage, frequency and time of administration;
• Written statement from the parent or guardian requesting administration of the medication in school; and
• Delivery of the medication to the health office by parent or guardian in a properly labeled “original” / pharmacy container. Elementary students are NOT allowed to carry medications to and from school.
At the secondary level, emergency medications such as epi-pens and inhalers can be carried by those students who are determined to be self-directed with written orders from the student’s medical provider.
A physical exam is required for all children entering this school system for the first time and for all children entering grades K, 2, 4, 7 and 10. Proof of this exam must be a signed physician’s physical appraisal form. [A physical exam performed within the 12 months prior to the start of the school year is acceptable. All forms are due by October.] If such an examination is not provided, the school is required by law to provide the exam at the school’s expense. We prefer that parents make appointments to have the family doctor complete the physical as he/she will perform a more complete physical exam and will give the required immunizations.
Recent changes to the New York State Education Law require that body mass index (BMI) and weight status category be included as part of the student’s required school health examination. The BMI helps the student’s medical provider know if the student’s weight is in a healthy range or is too high or too low. School districts are required to submit summary information on weight status category to the New York State Department of Health to help health officials develop programs to improve children’s health. No personally identifiable student information will be sent. Parents may choose to have their child’s information excluded from this reporting.
Required Immunizations for Attending School
* Please obtain a complete, signed written or electronic record of administered immunizations from your child’s Health Care Provider
Public Health Law 2164 requires that the following immunizations be received prior to a child being allowed to enter school:
• 3-4 IPV (Inactivated Polio Virus) *Note: 3 doses are adequate if 1 dose is given after age 4; 4 doses are required if 3 doses are given before age 4.
• 4-5 DTap, DPT, or Tdap ( Diphtheria, Tetanus and Pertussis) *Note: 4 doses are adequate if 1 dose was given after age 4, otherwise a 5th booster vaccine is required
• 1 Tdap (Tetanus, Diphtheria and Pertussis)*Note: Required only for students enrolling grades 6-12 who have not previously received a Tdap at 7 years of age or older
• 1 MMR (Measles, Mumps, Rubella) *Note: 2nd dose MMR required by age 7
• 3 Hepatitis B
• 2 Varicella (chickenpox)
BCSD needs proof of compliance with Public Health Law 2164 before your child may enter school. Adequate proof is certificate or record from the physician’s office or Health Care Clinic. Transcript records from other schools are NOT acceptable proof of immunization.
Demonstrated serologic evidence of measles, mumps, rubella, hepatitis B, varicella or all three serotypes of polio antibodies is acceptable proof of immunity to these diseases. Diagnosis by a physician, physician assistant or nurse practitioner that a child has had varicella disease is acceptable proof of immunity to varicella.
Please be advised that students not in compliance with the required immunization requirements, or those lacking proof of satisfactory progress toward completion, will be excluded from attending school until adequate proof is submitted.
Public Health Law also states that immunizations are not required where the parent(s) or guardian(s) “hold genuine and sincere religious beliefs” which are contrary to immunization. If this applies to you, please contact the school for the “Request for Religious Exemption to Immunization Form, Parent Guardian Statement”, from The University of the State of New York and The State Education Department. As per NYS law, the building principal may ask for further supporting documents to review when considering the religious exemption. Please contact your school nurse with any questions or concerns.
Please contact your school nurse if a medical exemption is required.
New York State Education Law 903, Chapter 281, permits schools to request a dental examination report for all newly enrolled students, and for students in grades K, 2, 4, 7, and 10. Dental Health Certificates are to be completed by parent or guardian and the child’s dentist. Completed certificates should be sent to your school nurse.
New York State Education Law, (Article 19, Section 905), and the Commissioner’s Regulations, Section 136.3, requires that schools provide the following health screenings:
• Vision screening for all newly enrolled students, including color perception, distance acuity, near vision, and hyperopia; in addition, all students in grades K, 1, 2, 3, 5, 7, and 10, will be screened for distance acuity.
• Hearing screening for all newly enrolled students, as well as for students in grades K, 1, 3, 5, 7, and 10.
• Scoliosis screening for all students in grades 5 through 9
Parent(s) will be notified if there are any concerns during their child’s screening. Results of all screenings will be documented in the student’s school health record.
All students who are ill or injured must be dismissed through the health office. Students are encouraged to report to the health office any illness or injury that occurred at school. This will ensure proper care and insurance claim processing.
The facilities in school are not designed to take care of ill or injured students for any length of time. Parents are expected to make arrangements to have their ill or injured child picked up at school.
The district carries accident insurance for all students in grades K-12. The insurance plan provides excess, or secondary, coverage. In the event of accidental injury to a student, parents should first submit the claim to their own health and accident carrier. If the claim is not payable or is in excess of the coverage provided, the remainder is submitted to the school plan for payment.
Interested students must sign up to participate in the athletics program through the health offices at the middle and high schools. The following forms are required to play a sport:
• Sport’s Update form for every season (to be completed by parent); and,
• Current physical exam. (Additional information may be requested such as illness/injury clearance).
If parents or students have any questions, (ie. deadlines, etc), please contact your school nurse.