Queen of the Holy Rosary - Wea School

22705 Metcalf RD
Bucyrus, KS 66013
913.533.2462

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Health Forms

- Parent Info

Health Forms
Hello QHR Parents,
Please read the following instructions for the Health Office forms packet. I am hoping that having this information up front will make filling out the forms easier. J The first 2 pages of the packet are information for you on Kansas Immunization Requirements (ONE for PRE-K and the OTHER for K-12^th grades).
**PRE K and KINDERGARTEN REGISTRATION WILL NOT BE COMPLETE until required immunization and physical forms are complete and turned in. If for some reason you cannot have the forms completed by the start of the school year please notify Nurse Lisa via E-MAIL ASAP.** lhiteshew@qhrwea.org
Here are the forms included in this packet with information on who needs to complete them:
- Child Health Assessment form – this is required by the State of Kansas for ALL PRESCHOOL, KINDERGARTEN, AND NEW STUDENTS regardless of whether it has been completed in the past. This form MUST BE COMPLETED AND SIGNED by a DOCTOR or NURSE PRACTITIONER.
- Kansas Certificate of Immunizations – Proof of immunizations is required by the State of Kansas for ALL PRESCHOOL, KINDERGARTEN, and NEW STUDENTS regardless of whether it has been completed in the past. You may have your physician complete this form OR send an immunization printout from your physician’s office. ***PLEASE be sure to provide updated immunizations if your student has received any NEW VACCINATIONS since last school year.***
- SPECIAL NOTE RE: IMMUNIZATION EXCEMPTION: If you wish to have your child be exempt from any or all immunizations YOU MUST CONTACT NURSE LISA via E-MAIL ASAP. You will be given special forms to complete.
- Queen of the Holy Rosary Wea Health History & Permit to Release Information. Completing this is important so that I have any pertinent health information on each student and this is also our CONSENT to obtain emergency medical care. Please fill out ONE FOR EACH STUDENT.
- School Nurse Medication Consent Sheet – This form is to be completed YEARLY, ONE PER FAMILY.
**STUDENTS WITH EPI-PENS and/or inhalers – parents, please complete an Allergy Action Plan/Asthma Action Plan form. These must be completed yearly. If you did not receive one in your packet and you need one please e-mail me and I will e-mail the form(s) to you. THANK YOU!
*Please do not hesitate to contact me if you have any questions regarding these forms. Thank you in advance for assisting me in keeping our students safe and healthy!
Lisa Hiteshew RN

lhiteshew@qhrwea.org
Forms