Jen Schierloh
District Nurse
513-563-5000 ext. 119

Permission to Administer Medicine Form

Immunization Information for 6th And 11th Graders

All grades levels: Rolling registration for fall and spring dates please complete form and send in to Nurse Jen and a representative from School Smiles will be in touch with you.

School Smiles Dental Registration Form


Dear Parents,

I would like to extend a warm welcome to all the student and parents! I am looking forward to working with you this 2019-2020 school year. To ensure your child's health and safety I would like to share a few items with you.

HEALTH CONCERNS: Please inform me of any severe allergies, surgeries, accidents, or new health problems that occurred during the summer months or which may occur during the school year.

MEDICATIONS: NO child is to take or carry PRESCRIPTION OR OVER THE COUNTER MEDICATIONS to school. If a child, by order of a physician must receive medications in school, it is required that both parent and physician complete the form prior to the administration of medication. Therefore, a prescription label IS NOT acceptable in lieu of an MD’s order. A written order must be obtained. You can find this form on the website or please call to have one sent home.

ILLNESS/ABSENCES: Please report your child absent and why he/she will not be attending. If your child has been ill, he/she should be free of a temperature and/or vomiting for 24 hours before returning to school.
If your child is diagnosed with any of the following communicable diseases please notify the nurse: strep throat, impetigo, scabies, head lice, pink eye, viral/diarrhea illness.

The exclusion time for each is: 

  • Strep Throat and Impetigo – 24 hours after initial dose of antibiotic and a doctor note

  • Scabies/Ringworm – 24 hours after initial dose of medication and a doctor note

  • Pink Eye (Conjunctivitis) – 24 hours after initial dose of medication and a doctor note

  • Head Lice – after hair has been treated student may return with no live lice but must return with a parent to be checked before returning to the classroom.

SCREENINGS: As per OH State Law vision and hearing screenings will be performed at certain grade levels. Both screenings will be conducted throughout the school year. If your child wears glasses please remind him/her to wear them every day. You will be notified only if your child does not pass the screening.

DENTAL PROGRAM: School Smiles is our dental program that comes and provides care to our students. Registration forms have already been sent home. Please reach out to me to send another registration packet home if you would like your child to benefit from this great program.

IMMUNIZATIONS: The following grades have immunization requirements that are due NOW and students in attendance at school must be compliant with the immunizations required by the state of Ohio:

  • All kindergarten students must have their complete immunization record and a record of a physical exam performed by a physician within the past year.

  • All 7th grade students must have documentation of the Tdap and Meningococcal immunizations.

  • All 12th grade students (including JVS students) must have documentation of the Meningococcal immunization. If the student had the immunization before the age of 16, a second shot is required. If the student had the immunization after the age of 16, only that one shot is required.

  • These immunizations are required by the state of Ohio (ORC 3313.67 and 3313.671). Any student who does not have the required documentation may be excluded from school and will not be permitted to attend school until the proper documentation is received in the health office.

I hope you find this information helpful. Please feel free to contact me with any questions or concerns.