- Unified School District 232
- Health Forms
Health Forms
Student Health Forms
-
Health Assessment Form
To be completed by health care provider approved to perform health assessments.
Parental Acknowledgement
-
Acknowledgement of Immunization & Physical Requirements
Acknowledgement form to be completed by parent/guardian.
Medication Permission Forms
-
Medication Permission Form (PDF)
Prescription medication form to be signed by the prescribing provider. Over-the-counter mediation form to be signed by parents/guardians.
Immunization Forms
-
Overview of Immunization Requirements
K.A.R. 28-1-20 defines immunizations required for any individual who attends school or a childcare program operated by a school.
-
Early Childhood Immunization Requirements
Kansas early childhood immunization requirements.
2023_2024 _School_Requirement_Memo_Childcare_Facilities_and_Programs_Operated_by_Schools.pdf 177.94 KB (Last Modified on April 24, 2023) -
Kansas Certificate of Immunizations (KCI) form
Required form to be completed by a licensed physician. Parents or guardians are not authorized to complete the form.
-
Kansas Certificate of Immunizations - Form B - Medical Exemption
KCI Form B - Medical Exemption. A Medical Doctor (M.D.) or Doctor of Osteopathy (D.O.) must complete this affidavit.
Health forms in Spanish
-
Visión general de los requisitos de inmunización
Overview of immunization requirements.
Spanish_Immunization_Requirements_for_2018-2019_School_Year_Cheat_Sheet.pdf 513.04 KB (Last Modified on January 25, 2018) -
Reconocimiento de inmunización y requisitos físicos
Acknowledgement of immunization and physical requirements.