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Health Services Forms
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Student Immunization Form
Minnesota law requires children enrolled in child care, early childhood education, or school to be immunized against certain diseases, unless the child is medically or non-medically exempt.
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Kindergarten Registration Health Care Summary
To be completed by health care provider and submitted with Kindergarten registration materials.
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Emergency Card Update
Use this form to update emergency contacts for your child, or log in to Family Access to update contact information
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Administration of Any Medication During the School Day
This form is for parents of students requesting that any medication be administered during school hours by school staff.
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Self-Administration of Non-Prescription (Over-The-Counter) Medication During the School Day
This form is for parents/guardians of high school students requesting that a non-prescription medication be self-administered during school hours by the student.
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Allergy/Anaphylaxis Action Plan
If your child has a severe allergy that requires medication and/or an EpiPen, please complete the Allergy Action Plan Form. Return it to the school's health office with the medication your child may need in the event of exposure to an allergen.
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Asthma Action Plan
This form provides consent for school to administer asthma medicine(s) as provided by parent or guardian and allows the child to carry the inhaler for which the provider has assessed ability and if approved by the school nurse. Plan given and reviewed with patient and/or parent.
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Diabetes School Guide
This plan should be completed by the student’s personal diabetes health care team, including the parents/guardians. It should be reviewed with relevant school staff and copies should be kept in a place that can be accessed easily by the school nurse, trained diabetes personnel, and other authorized personnel.
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Seizure Action Plan
Once this Seizure Action Plan has been filled out, take a copy for the school nurse to keep.