Required Health Forms
From immunizations to physical examinations, student health is an important school and community preparedness issue. Below are links to required health forms that verify students receive routine health screenings and services. These completed forms become part of each student's school records.
You will need Adobe Acrobat Reader to open and print these forms. If your personal computer is not already equipped with this free software, the 
button on the right side of your screen will activate the download and installation processes.
After you have completely filled out each appropriate form, bring it or send it with your child to school. If you should have any questions, please feel free to contact Mrs. Sagehorn, school nat either 654-3317 ext. 128 or 654-3315.
Application for Certified Copy of Birth Certificate
Summary of School Immunization Rules & Regulations
Specific immunizations are associated with specific ages. Please, review regulations carefully. The Three Rivers Health Department (located at 33 W 4th St in Fremont) sponsors an immunization clinic on Mondays from 9 AM to 6 PM; however, you will need to call ahead for an appointment at 402-727-5396 or toll-free 866-727-5396.
Physical Examination Requirements
Physical examinations are required of
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- all students with grade placements Kindergarten and 7
- all newly enrolled students from out of state, regardless of grade placement
- all students participating in extracurricular sports practices, each participating year
A School Vision Evaluation is required for all children within six months prior to entering Nebraska schools for the first time.
Parental Request for In-school Medications
Parental consent forms are necessary if students receive medication during the school day. Medications must be dispensed according to prescribed dosages by the school nurse or an authorized school official.
New State Laws Concerning Chicken Pox Vaccine
Beginning with the 2011-2012 school year, students will need to provide documentation of receiving 2 doses of the varicella (chicken pox) vaccine. The school nurse needs either the form above, OR, if the student has actually had the disease, the form below on file.
Documentation of Varicella (chicken pox) Documentatcion de Varicela
Asthma Documentation -- Documentation de Asma
Health Questions -- Cuestionario de Salud
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