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Clinic Forms



Emergency Medical Form (School Year 2018 - 19)
(This form must be completed yearly for all students and returned to the school by the first day)
Medication Administration Record (MAR)
(This form must be completed for each over-the-counter medication and for each prescribed medication. This form is not needed for any medications that are included in the specific health care packets.) 
(These packets are only to be used for students that have a diagnosis from
a physician. These packets must be completed by physician and guardian each year.)
  • Diabetes Packet (In addition to this packet, a diabetes management form, which can be obtained from your child's health care provider, must be completed by your child's physician each year.)


The Austintown Local School District is a united community with a proud legacy and a progressive approach to education.

Contact Us
Austintown Local Schools 700 S. Raccoon Road
Austintown, OH 44515
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phone icon white  Phone: 330.797.3900
fax icon white  Fax: 330.792.8625
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