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Hutchinson Public and Parochial School
Student Health Form

MINNESOTA LAW REQUIRES STUDENTS BE UP TO DATE WITH IMMUNIZATIONS IN ORDER TO ENROLL IN SCHOOL.
School Year
Your answer
Student Name
Your answer
Birthdate
MM
/
DD
/
YYYY
Grade
Your answer
Does your child have any medical problems or illnesses?
If yes, please specify.
Your answer
Does your child have any mental health or behavioral needs?
If yes please specify.
Your answer
Does your child take any medications?
If yes, please specify:
Your answer
Does your child have any allergies?
If yes please specify:
Your answer
Does your child have asthma?
Does your child have a prescribed Epi-pen?
Has your child ever had a seizure?
Does your child have any hearing or vision concerns?
If yes, please specify:.
Your answer
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