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Important Documents & Forms

Many activities at Lakewood Catholic Academy, from registration to graduation, involve forms or documents! Below you'll find links to to many of the most commonly used forms as well as some key documents in easily printable PDF format.

General Forms & Documents

Email Request Form

Complete and return this form in order to receive the weekly electronic newsletter for parents.

Summer Reading & School Supply List

Field Trip Form

Facility Request Form

Parent Checklist

Student Acceptable Use Policy

School Entrance Physical Examination Form

Emergency Medical Authorization Form

Legal Custody Agreement Form

Parent Handbook Agreement & Computer Use Agreement/Parent Permission Form

Picture Release & Lunch Room Form

Cellular Phone Policy Form 

Band Participation Form

Saints Service Organization Forms

Expense Reimbursement & Check Request Form

Event & Program Revenue Worksheet

Directory Order Form

Cafeteria Forms

2012-13 Cafeteria Order Form (Includes all months)

April 2013 Cafeteria Menu

May 2013 Cafeteria Menu

Medical Forms

Health Questionnaire & Immunization Record Form

Provides LCA with a record of your child's required immunizations.

Booster Dose Td/Tdap Information Letter & Form

Effective with the 2010-11 school year, the Ohio Department of Health has revised the School Immunization Requirements to include a dose of Td or Tdap to be administered before a student enters the seventh grade. Therefore, your current sixth grader will need to show proof of having received this booster dose before returning to school in the fall.

Emergency Medical Authorization Form

This form is required to be completed for each student, every year. The form is required by law and is used to allow emergency medical treatment in case of an accident. There is a line on the form that allows parents to note an allergy issue or whether the child is currently on any medication, even if it is not given at school. Emergency room doctors need to know if a patient is on any medication.

Physician & Parent  Request for the Administration of Medicine by School Personnel

This form permits the administration of medicine to the student by the school nurse.

Allergy Action Plan

Should your child have food or other allergies, this form allows your physician to permit the administration of  one or more allergy medications to your child during school hours.

Form to Authorize Student Possession and Use of an EpiPen

This is a form that allows a student to carry and self-administer an EpiPen allergy treatment. Please note that it is required by law that if your child carries an EpiPen, a second one should be kept under the child's prescription in the nurse's clinic.

Self Medication for Asthma Inhalers Form

This form will allow your child to carry and use an inhaler during school hours. Some parents choose to keep a back-up inhaler with the nurse in the school clinic. This form also allows the nurse to provide the inhaler to the child.

Diabetic Health Care Form

This form provides the nurse with comprehensive information related to the treatment of a student with diabetes.

Seizure Action Plan

This form should be completed for students being treated for a seizure disorder.

Athletics Forms

CYO Physical Form

This form is required to be completed prior to participation in any practice or game. The form is good for one year - if you submit a form completed by your child's doctor prior to the start of a school year, the form should be valid for the entire sports year.

CYO Coaching Application Form

This form must be completed by all coaching candidates.


Lakewood Catholic Academy  *  14808 Lake Avenue  *  Lakewood, OH 44107  *  216.521.0559  * Contents © 2009, LCA