The Lab School of Washington

4759 Reservoir Road, NW 20007 Washington, DC
Phone: 202-965-6600

Dear Parents and Guardians:

Student health and safety are a priority at The Lab School of Washington. School physicals, immunizations, dental exams and emergency contact data are annual requirements. Now is the time to make medical and dental appointments. Please do not wait until summer’s end. Health and emergency forms are posted below. 

July 1, 2016 Mail or fax forms to:
Judy Brinckerhoff, RN, MSN, School Nurse
The Lab School of Washington
4759 Reservoir Road, N.W.
Washington, DC 2007
Telephone: 202-944-3078 or Fax: 202-454-2342



Student Contact and Emergency Form

All Students (New and Returning) must submit the Student Contact and Emergency Form.  

DUE JULY 1,  2016.
  • Student Contact and Emergency Form
    • Student contact and emergency data are essential to the enrollment process.  We consult this form on a daily basis to notify parents when a student is ill, injured or in need. Please advise the school nurse when emergency contacts, health status, or medications change. 
    • Teachers regularly review the Student Contact and Emergency Form for allergy and safety concerns as they plan class activities, field trips and celebrations.
    • In the absence of a parent, we may need to transport a student to the hospital via emergency medical services.  Accurate health insurance, medication, and allergy information expedite the emergency triage process.
    • Dismissal safety, both daily and in an emergency, is a priority.  Please list the names and best contacts of all adults authorized to transport your child.
    • The Student Contact and Emergency Form is fillable online.  Please date and sign the form.

Physical Exams

The District of Columbia requires a physical exam every year. The District of Columbia Universal Health Certificate documents vision and hearing screenings, immunizations, tuberculosis assessment, physical exam and athletic clearance.

DUE JULY 1, 2016.
  • District of Columbia Universal Health Certificate
  • District of Columbia Universal Health Certificate Instructions
  • District of Columbia Immunization Requirements
  • HPV Opt-Out Form
    • New Students are asked to submit physical exams by July 1, 2016. Contact the school nurse if you have questions or a concern.
    • Returning Students (those enrolled in LSW for the 2015-16 school year) - If your student has a current District of Columbia Universal Health Certificate on file at school it is not necessary to re-send last year's physical.  We will accept physicals for the 2016-17 school year dated after August 29, 2015.
    • IMPORTANT.  Athletic clearance is valid for 365 days.  If your Intermediate, Junior High or High School student participates in interscholastic athletics, his or her clearance expires 365 days from the date of the exam.   Students are not eligible to practice or play without current athletic clearance.  For example, if the date of your student's physical is August 30, 2015 he or she is ineligible to practice or play fall 2016 fall sports.
    • We recognize insurance regulations regarding annual well-child physicals.  Your insurance plan may not cover an annual physical until late July or August.  If this situation applies, please forward updated physical examinations, athletic clearances, and medical authorizations obtained after July 1, 2016 to the school nurse as soon as the examination is complete.    We ask that you retain copies of all health and emergency submissions for your records.
    • We closely monitor immunization compliance.  DC law requires our students to receive the age appropriate immunizations posted in the guidelines on our website.  Students at age 11 years are required to receive a Meningitis, Tetanus Booster and the Human Papillomavirus (HPV) vaccine or submit the  HPV opt-out form.  Parents and guardians with questions regarding medical or religious exemptions should contact the school nurse.
    • LSW may send home students who fail to demonstrate proof of required vaccines within 10 days of written notification.

District of Columbia Oral Health Assessment

DUE JULY 1, 2016.

Combined Medication Authorizations

DUE JULY 1, 2016.
  • Combination Medication Consent Form
    • LSW Authorization for the Administration of Medication  and LSW Authorization for the Administration of Non-Prescription Medication are combined on one form.  
      Please note that we require both parent and physician authorization for the administration of any medication, whether prescription or over the counter. Parent signature alone is not acceptable.
    • We encourage you to ask your student's health care provider to complete this form at the time of the annual physical.  These authorizations are especially important for emergency medications, after school medications, allergy relief and field trips.  Students who plan to participate in After School, Junior High Field Trips such as The Teton Science School,  High School Global Travel, Diversity Conferences, Model UN, Tide Turners and the Senior Trip to Disney must have parent and physician authorizations for both prescription and non-prescription medication.

Action Plans for Students with Chronic Medical Conditions

DUE JULY 1, 2016.
  • Asthma Action Plan
  • Seizure Action Plan
  • Anaphylaxis Action Plan
    • Students with medical conditions such as asthma, life-threatening food allergies or seizures - The District of Columbia authorizes students to carry emergency medication and hand held inhalers with both parent and physician permission.
    • Action Plans are available on the the website. If your student has a history of these conditions, please complete the forms with your student's physician. Please note if your student is competent to self-administer inhalers and or EPI PENS
    • Available Actions Plans include : Asthma Action Plan, Seizure Action Plan and Anaphylaxis Action Plan.
    • The school nurse will gladly work with students and families who require an individualized health care plan. Parents are asked to contact the school nurse with questions.

For more information, please contact:

List of 1 members.

The Difference is Extraordinary

The Lab School of Washington

4759 Reservoir Road, NW | Washington, DC 20007-1921 | 202-965-6600