Medical Forms

For Children Entering Preschool (Seedlings) and Pre-K (Sprouts)

Preschool students are required to complete a child medical history and child medical statement form. 

Child Medical History

Child Medical Statement

Child Medical Record/Immunization

Students Entering Kindergarten 

Kindergarten students are required to submit a completed/updated immunization form verifying the child's vaccinations required by the State of Ohio.

Child Medical Record/Immunization

7th Grade Immunization Form

Medication Administration Policy & Forms

Medication Administration Policy

Request for the Administration of Over-the-Counter Medication Form

Physician's Prescribed Medication Request Form

Student Medical Action Plan Forms

Asthma Action Plan

Seizure Action Plan

Forms may be emailed to Linda Miyares at or mailed to:

Birchwood School of Hawken
4400 W 140th St
Cleveland OH 44135