DC GOVERNMENT

info@dc.gov

Office of the Chief Technology Officer, Washington, DC, US

Print Document

When you click Print below we will prepare a printable document for you. It will automatically download when it's ready.

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You can fill in the document online and then click the print icon and all of your information will be populated in the printable document, saving you time later.

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Your Name HereClick to Sign

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08/31/2025Click to Sign

Signature HereClick to Sign

Your Name HereClick to Sign

08/31/2025Click to Sign

Additional Signatures Required

Upload Attachment(s)

Please upload the following attachments. The Universal Health Certificate (front and back side) is required to submit the form. Other documents may be required depending on your child's medical condition.

There is a 250MB limit on each attachment.

Universal Health Certificate (Physical) - front side Click Here to Upload

Universal Health Certificate (Physical) - back side Click Here to Upload

Asthma Action Plan (if needed) Click Here to Upload

Anaphylaxis Action Plan (if needed) Click Here to Upload

Any Additional Paperwork from Doctor (if needed) Click Here to Upload

Sign Now!

Please provide accurate information below to ensure the delivery of the signed copies of the document.

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