Health Records Form

This form is available when pre-registering students for the school year and only needs to be filled out for new students or when something needs updated. You can not include multiple children on the same form submission. 

Student Name
Home Address
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Sex
Parent / Guardian Name
Give approximate date
Give approximate date
Give approximate date
Operations
Allergies
Other frequent health problems
IMMUNIZATION DATES PROVIDED BY PHYSICIAN OR CHIRP REPORT:
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Boosters for 6-8th Grade
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