Intermediate School Forms

*Emergency Medical Release Form
We need this form on file for every student each school year.

Acceptable Use Form
By signing this form you are agreeing that you (or your child if they are under 18) will not misuse the school’s technology in any way.

Allergy Information
Please fill out this form if your child has allergies that require special requirements during school.

CIS Communications Guidelines
This form gives the parents the right to opt their child out of directory information and communication tools.

Free & Reduced Lunch Form
Chippewa Local School District offers the free/reduced national school lunch program.  Those of you who were on the program last year will remain on the program and have until October 1st to complete and send in a new application for this year.  

All may apply for the free/reduced lunch program.  The application is family based, so there is no need to fill out multiple forms for siblings.  They can all be listed on the same form.  Forms can be obtained online & at any school building.

To see if your household qualifies for free or reduced lunches, please print, complete & return application to appropriate building for approval.   You may also send completed application to:

Chippewa Local Schools Food Service
56 North Portage Street
Doylestown, Ohio 44230

You may apply to the free and reduced lunch program at any time during the school year and reapply as needed if you experience changes to your income.

Free & reduced information will remain confidential.

Medication Request Form
Please fill out thIs form if your child needs medication at school.  We must have this form on file if your child needs to take medication during the school day or needs to keep any kind of medication with them (ex. epi pen, inhaler)

Policies and Procedures in the Student-Parent Handbook
Each student and their parent or guardian needs to sign this form stating you read the policies and procedures in the CIS Handbook.