Health Services

General Health Forms

Click here for Physical Examination Form

Click here for Dental Exam Form

Click here for Eye Exam Form

Click here for Physicians Medication Authorization Form

Emergency Action Plan Forms

Care Plan Forms for Health Conditions

Click here for Diabetes Action Plan



 Immunizations Required:

  Dtap - 4 or more                                        Rubella - 2

  Polio - 4 or more                                        Hep B - 3

  Measles - 2                                                Varicella - 2

  Mumps - 2

  • Current Physical (including LEAD and DIABETES screening-on physical)
  • Vision Exam (by an optometrist)
  • Dental Exam Turn in by May 1, 2020
  • Parent Consent Form


1st Grade:

  • Parent Consent Form

2nd Grade:

  • Dental Exam Turn in by May 1, 2020
  • Parent Consent Form

3rd Grade:

  • Parent Consent Form

4th Grade:

  • Parent Consent Form

5th Grade: 

  • Parent Consent Form

6th Grade:

Immunizations Required:

   1 Meningococcal Vaccination on or after 11th birthday

   1 Tdap

Proof of the following vaccinations:

  MMR 2

  Varicella 2

  Dtap 4 or more

  Polio 4 or more

  Hepatitis B 3

  • Current physical (sports physical does not qualify)
  • Dental Exam Turned in by May 1, 2020
  • Parent Consent Form

7th Grade:

  • Parent Consent Form

8th Grade:

  • Parent Consent Form

9th Grade:

Proof of the following Vaccinations:

  Dtap - 4 or more                                              Varicella 2

  Polio 4 or more                                                Meningococcal 1

  MMR 2                                                             Tdap 1

  Hepatitis B 

  • Parent Consent Form

10th Grade:

  • Parent Consent Form

11th Grade:

  • Parent Consent Form 

12th Grade:

Proof of 2 Meningococcal Vaccinations


Parent Consent forms are available online. These forms need to be filled out each year for medical concerns. Also, if you want your child to take Tylenol or Ibuprofen as needed, at school.

If you have any questions please contact me, Sherry Hafer at 284-7723 ext. 4003, or contact your school nurse. 

Thanks for your cooperation

Sherry Hafer RN

District Nurse

 Meet Your Nurse

Sherry Hafer

District Nurse


284-7723 ext. 4003


Chris Pierce

Dixon High School


Cindy Hoyle

Reagan Middle School


Courtney Forristall

Madison School 


Amanda Costello

 Jefferson School


Joyce Faivre

Washington School


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