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Health Services Forms

Well Exam/Physical Exam
New Required NYS Health Examination Form-  Per NYSDOH only this form will be accepted starting January 31, 2021. If your child's healthcare provider does not use this form or a similar form with the same components, you will need to take this form with your child's well exam appointment. Our area pediatric practices have an electronic form that is compliant with this NYS mandate. Please contact the building nurse if you have questions. 

Health History
Student Health History  (to be completed by all new students and when entering a new building in the district) Release of Information
Health Information Confidentiality Release Form

Miscellaneous Forms
BMI Reporting-Opt Out Form
Hearing Screening Notification Opt Out Form
NYS Dental Certificate Please submit a completed dental certificate with mandated health examination. 

Fieldtrip
Field Trip Medical Form LMS
Field Trip Medical Form LCSD High School


Physical Education/Recess Particiption
Physical Education and Recess Participation Checklist-Lansing Middle School

Sunscreen
Sunscreen Permission Slip