Frequently Requested Forms

This page contains links to frequently requested forms in the district, including academic, athletic, health, food services, enrollment, volunteering and contacting the board of education.

Back to School and Emergency Medical Information Forms

Completing and Updating Your Back To School / EMA Form

For custodial parents of returning students in kindergarten through grade 12

In order to complete back to school and EMA forms, a parent/legal guardian will need to submit an annual update for each returning student through the Infinite Campus Parent Portal.  Please follow the directions below for the online registration annual update:

  1. Login into your Infinite Campus Parent Portal, click on the 3 lines in the upper left corner and select “More.”
  2. Click on Online Registration on the bottom of the list.
  3. Click on Existing Student Registration

Infinite Campus pic showing buttons for existing student online registration annual update instructions

4. Click on Begin Registration at the bottom.

Infinite Campus Online Registration pic showing Begin Registration button

5. Follow the prompts to complete the Online Registration Annual Update.

New items to be added for a current student will be doctor, dentist, hospital information, etc.  Please review all other information, including emergency contacts, health conditions and medications.

 

If you have any questions, please see our Infinite Campus webpage for instructions regarding your Infinite Campus Parent Account and submitting an Infinite Campus help desk ticket.

Academic Forms

Change of Student Information / Change of Address

Any changes to a student’s home address must be requested on the district’s change of student information form and processed through the Welcome Center.

Download the change of address form as a PDF |  Change of Student Info/Address (RTF)

Download the change of address form as a Word document.

Field Trip Permission Form

Blanket field trip permission forms are now included in our annual online registration update through the parent portal of Infinite Campus.

Photo / Video Opt Out Form

Parents who wish that their children not be included in videos or photos taken by the district for use in publications and online use (social media, district website, etc.) must fill out the photo/video opt out form (PDF) | photo/video opt out form (RTF).

Request a Transcript

Pickerington High School Central Current and Former Students

Current students

Download this student transcript request form (PDF), complete it (including parent signature), and return it to your guidance counselor. Student transcript request form (RTF) version

Alumni

Complete this online transcript request form for PHSC graduates. This request must be made at least 10 school days before the deadline.

All transcript requests are due 10 days prior to specific college deadlines.

 

Pickerington High School North Current and Former Students

Current Students

Fill out the transcript request form in the School Counseling office (or download and print) and submit the form to Mrs. Chandler.  Reminder – transcript requests are due 10 school days prior to specific college deadline.

Transcript Request Form (PDF)

Transcript Request Form (RTF)

Alumni

Complete this online transcript request form for PHSN graduates. Transcript requests are due 10 business days prior to specific college deadlines.

Work permit forms

Please Note: minor work permit applications must be signed by the administration at one of the high schools (Central or North).  The District Office does not process the minor work permit applications.

Application for minor work permit (PDF) | Application for minor work permit (RTF)

Physician’s certificate for minor work permit (PDF) | Physician’s certificate for minor work permit (RTF)

Athletic Forms

PHSN Daily COVID-19 Screening Form for Student Athletes

Please submit the appropriate form daily, prior to the student attending the sport/activity.

Band

PHSN Band

 

*See coaches for daily athlete screening form

Fall Sports

Winter Sports

Spring Sports

Volunteer Form

Individuals interested in volunteering in our schools must fill out an application.

Enrolling and Open Enrollment

Intradistrict Building Transfer Request (Previously 'Open Enrollment')

This form is for parents to request that their children be allowed to attend school in a building in a different attendance area than the one they would normally be enrolled in based on where the student lives.

2019-20 form (PDF) | 2019-20 form (RTF)

2020-21 Form (PDF)2020-21 Form (RTF)

Friends and Family Affidavit

Friends and Family Affidavit (PDF)

Friends and Family Affidavit form (RTF)

Please note that the RTF version is for accessibility only. Please print the PDF version to turn in to Welcome Center.

Kindergarten Enrollment

Speech Pathologist Survey (PDF) | Speech Pathologist Survey (RTF)

Friends and Family Affidavit form (PDF)

All incoming Kindergarten Students are required to provide the completed Physician Report Form (see below) including Immunization Records. Please turn in the completed form to the school your child will attend before August 1, 2019. Immunization Requirements are outlined per the Ohio Department of Health. If you have any questions, please contact your school nurse or Sharon Schmitz.

Physician’s Report (PDF) | Physician’s Report (RTF)

Health and Medical

Asthma Action Plan

Please complete both forms below as needed for medication administration:

Request for administration of medication by school personnel

Asthma Emergency Action Plan

If you have any additional questions, please contact your school nurse.

Kindergarten physical

All incoming Kindergarten Students are required to provide the completed Physician Report Form (see below) including Immunization Records. Please turn in the completed form to the school your child will attend before August 1, 2019. Immunization Requirements are outlined per the Ohio Department of Health. If you have any questions, please contact your school nurse or Sharon Schmitz.

Kindergarten physical form

Student Insurance

Pickerington Schools has made arrangements with Student Protective Agency to provide optional student accident insurance for those wishing to purchase coverage this year.

Please note that this is a strictly voluntary student accident insurance coverage that the district makes available to parents as a courtesy.  The full cost of the premium is paid by the parent/guardian. If there is a claim during the student day, the claim must be certified by a school official. If the claim happens during a non-school 24-hour period or over the summer, the parent completes the claim.

Brochure

Application (pdf)

Please note the coverage shown on the application. Covered losses less than $250 are paid without regard to other insurance.

Senior high football coverage requires an additional premium. All other school supervised sports are covered under the plan. On claims over $250 this is an excess coverage policy for which benefits are payable only for that part of the loss not covered by other collectible insurance. If a person has no other insurance, the company will pay the covered medical expenses incurred within one year, up to the specified limits of the policy.

Complete the application and check the boxes for coverage desired. Tear off and keep the rest of the application, as it shows not only the coverage but the exclusions and limitations of the policy.

Mail the applications directly to Student Protective Agency, 300 Coshocton Avenue, Mount Vernon, OH 43050 along with a money order of check payable to Student Protective Agency. The school will be notified as to who takes out coverage. You can call Student Protective Agency at 800-278-2544 for more information.

In case of an accident the student or parent should immediately go to the building principal who will sign and provide the claim form if only school time coverage is taken out. 24-hour coverage needs no signature. The policy number shall be provided by the school for the claim or you can call 800-278-2544. You may give that policy number to the doctor or hospital but the bills should be sent to the parent or guardian who attach them to the claim form. Once completed, mail to the claims office at Guarantee Trust Life Insurance, PO Box 1148, Glenview, IL 60025.

If you have any further questions regarding a claim, please call 1-800-622-1993. It is the responsibility of the parent or guardian to file the claim.

Tdap and MCV4 Immunization (Required for Grade 7)

Immunization letter and physician’s form – grade 7 (PDF)

Immunization letter and physician’s form – grade 7 (RTF)

Per the Ohio Department of Health, all 7th graders must show documentation of receiving both the Tdap and MCV4 immunizations before the start of school in 2020-2021.

Previously, Pertussis (the “P” in the immunization) had not been required after the age of 7. Due to an increase in outbreaks of Pertussis (also known as Whooping Cough) the Department of Health has decided that a booster is needed.

You may take this letter with you to your doctor to use as documentation of this vaccination, or you may submit an immunization report with the dates of the Tdap and MCV4 vaccinations. Please return this documentation as soon as possible to your child’s school nurse. If this is not provided during the 6th grade school year, you will need to send this information to the Junior High that your child will attend in 2019-2020, prior to the beginning of next school year. The middle school nurses will forward on all immunization documentation received to the junior high nurses at the end of this year. Student schedules will not be released until this requirement is met. If you have any questions, please contact your school nurse, or Sharon Schmitz, School Health Supervisor.

MCV4 Immunizations Required for Grade 12

Immunization letter and physician’s form – grade 12 (PDF)

Immunization letter and physician’s form – grade 12 (RTF)

Per the Ohio Department of Health, all 12th graders must show documentation of having received 2 doses​ ​of​ Meningococcal​ ​(MCV4)​ immunization before being allowed to enter school in 2020-2021. This is a new requirement for this age group.

Per the Ohio Department of Health, all 12th-grade students must provide documentation of receiving 2 MCV4 vaccinations before the start of school in 2020-2021. You may take this letter with you to your doctor to use as documentation of these vaccinations, or you may submit an immunization report with the dates of the MCV4 vaccinations. Please return the documentation as soon as possible to your child’s school nurse. If this is not provided during the 11th grade school year, you will need to send this information to the High School your student will be attending in 2019-2020, prior to the beginning of next school year. Student schedules will not be released until this immunization requirement is met. If you have any questions, please contact your school nurse, or Sharon Schmitz, School Health Supervisor.

The second dose must be administered after the 16th birthday. If the 1st dose of MCV4 was administered on or after the 16th birthday, a 2nd dose is not required.

Food Services

Free and Reduced-Price Meals Information

Free/reduced-price meals: Your children may be eligible for free or reduced-price meals. If you wish to apply for meal benefits, please read the instructions below and complete the application. Fill out the federal application online or download, print, and complete the applicationUse one application for all students in your household. We cannot approve an application that is not complete.

 

Transportation

Change of Bus Stop

If there is a change that needs to be made regarding your student’s pick-up or drop-off sites, please log in to the online system and click on the “Parent Communication” link.

Volunteering

Volunteer in Our Schools

Individuals interested in volunteering in our schools must fill out a volunteer application (PDF) | volunteer application (RTF) and submit it to a building principal.