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2025-26: Student Health Information
Dear Parent/Guardian: The American Academy of Pediatrics recommends children receive a physical examination annually. Health information is vital in planning and supporting students while attending school. Please provide us with current health information each school year. State Law (M.S. 121A.15 & M.S. 144.29) requires your child be immunized or submit notarized conscientious exemption documentation as well as receive a comprehensive physical examination before entering Kindergarten or elementary school. *Information entered into this form is maintained by a HIPAA compliant Google Suite with BAA.
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Email *
Grade (2025-26) *
Last Name *
First Name *
Middle Name(s)
Date of Birth *
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Parent/Guardian Contact Info: name(s) and phone number(s) *
Emergency contact that is authorized to pick-up your student from school if you cannot: name and phone number *
List anyone who is NOT authorized to pick-up your student from school: name and phone number
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