New Student Forms
Please complete and turn in the following:

  • Emergency Form (doctor signature not required unless your child has a medical condition)
  • LCYC Student Pick-up Authorization Form
  • Health Inventory Form
    • Part I (page 2) of Health Inventory Form-parent complete and sign
    • Part II (page 3) of Health Inventory Form-physician complete and sign
    • Immunizations – attach a computer generated immunization record or complete this form from your physician’s office. Vaccination Requirements
    • Blood Lead Testing Certificate – If your child’s birthday falls after 1/1/15, have physician complete where indicated.
  • LCYC Student Allergy Form
  • If your child has allergies, Asthma (requiring medication at school), seizures, or will require medication (epipen, benadryl, etc.) to be given at school, please complete the appropriate forms with your physician. Find the form under the heading “Medical Forms” below. Contact the LCYC office for more information.
  • Subscribe to the LCYC list serve – subscribe both parents/guardians if you both want to receive email communications from LCYC.

  • Forms must be completed and returned to LCYC before your child can start school. Parent can send them via email to, fax: (301) 933-7704, or mail to LCYC, 10123 Connecticut Ave., Kensington, MD 20895


Student Forms
Miscellaneous Forms – As Needed
Consumer Education Form; link to Consumer Education on Child Care brochure
Medical Forms – As Needed
Allergy Action Plan (Must be accompanied by the Medication Admin. Auth. form)
Asthma Medication Admin. Auth. Form
Immunization Certificate
Lead Blood Testing Certificate
Medication Administration Authorization
Seizure Medication Authorization
Vaccination Requirements