Health Services


Click here for the Health Examination Form

Click here for the Dental Exam Form

Click here for the Eye Exam Form

Physicians Medication Authorization Form & Guidelines


Care Plan Forms for Health Conditions

Diabetes Care Plan Form



Current Physical including:  Lead screening and Diabetes Screening (on physical)


  Dtap - 4 or more

  Polio - 4 or more

  Measles - 2

  Mumps - 2

  Rubella - 2

  Hep B - 3

  Varicella - 2

Vision Exam: by an Optometrist

Dental exam:  Turn in by May 1, 2018

Parent Consent Form


1st Grade:

Parent Consent Form


2nd Grade:

Parent Consent Form

Dental exam:  Turned in by May 1, 2018


3rd Grade:

Parent Consent Form


4th Grade:

Parent Consent Form


5th Grade: 

Parent Consent Form


6th Grade:

Current Physical (sports physical does not qualify)

Dental exam:  Turned in by May 1, 2018

Immunizations:  Proof of 2 MMR, proof of 2 Varicella, 1 Tdap, 1 meningococcal-after 11th birthday

  Dtap - 3 or more

  Polio - 3 or more doses

  Hep B - 3

Parent Consent Form


7th Grade:

Parent Consent Form


8th Grade:

Parent Consent Form


9th Grade:

Parent Consent Form

Proof of Immunizations:

  DTAP - 4 or more

  Polio - 3 or more

  MMR - 2

  Hep B - 3

  Varicella - 2

  Meningococcal - 1

  Tdap - 1


10th Grade:

Parent Consent Form


11th Grade:

Parent Consent Form 

12th Grade:

Immunizations: Parent consent form & Proof of 2 meningococcal vaccines


Parent Consent forms are available online or at school registration.  These forms need to be filled out each year, for medical concerns and for the student to be able to take Tylenol or Ibuprofen at school as needed. 

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


 Meet Your Nurse

Sherry Hafer



District Health Coordinator


Vanessa Rubright


Dixon High School

Chris Pierce



Reagan Middle School/Madison School




 Madison School



 Jefferson School

Joyce Faivre


Washington School

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