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Loyalsock Township School District

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Medical Forms/Protocols

Medical Forms & Medication Protocol

Anaphylaxis Allergy Medication Order Form-Emergency Care Plan (FARE form)

Asthma Inhaler Provider Order Form

Parent Consent Form for Inhaler

Medication Protocol

Medication Order Form-Provider Orders

Parent Consent Form for Medication(s)

Private Dentist Report Form (Entry, grades 3 & 7)

Private Physical Exam Form (Entry, grades 6 & 11)

Mobile Dentist Form

School Nurse First Aid Form

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  • Donald E. Schick Elementary

  • 2800 Four Mile Drive
  • Montoursville, PA 17754
  • Phone: (570) 326-3554
  • Fax: (570) 326-1498
  • Loyalsock Middle School

  • 2101 Loyalsock Drive
  • Williamsport, PA 17701
  • Phone: (570) 323-9439
  • Fax: (570) 322-3952
  • Loyalsock High School

  • 1801 Loyalsock Drive
  • Williamsport, PA 17701
  • Phone: (570) 326-3581
  • Fax: (570) 323-5303
  • Loyalsock District Office

  • 1605 Four Mile Drive
  • Williamsport, PA 17701
  • Phone: (570) 326-6508
  • Fax: (570) 326-0770
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