GRAND RAPIDS HEALTH SERVICES
Health Information for Robert J. Elkington Middle School Students
Please contact Amy Holt, RN if any of the information submitted changes at (218) 327-5800 ext. 41211 or aholt@isd318.org. 

Sign in to Google to save your progress. Learn more
Student First Name *
Student Last Name *
Birth date *
MM
/
DD
/
YYYY
Grade *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of ISD 318.

Does this form look suspicious? Report

Google Forms