Health Services Forms & Documents

Medication Authorization Form

Free Vaccinations!

Immunization Clinic - Ephrata Church of the Brethren

Immunization Clinics - Penn Medicine ChildProtect

Sunscreen Permission Form

Emergency Health Plan

Asthma Action Plan

Dental Form

Dental exams are required upon original entry to school, third grade, and seventh grade.

Emergency Information

This form is used to provide emergency contact information for your child.

Health History Form

Nurse's Emergency Manual

Physical Form

Physical exams are required upon original entry to school, sixth grade, and eleventh grade.

Seizure Action Plan

This form provides the nursing staff with specific guidelines to assist your child with seizure monitoring and treatment.

Type 1 Diabetes Parent Fact Sheet

Type 1 Diabetes Parent Fact Sheet - Spanish