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
**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

NOTE for PRE-K and KINDERGARTEN PARENTS/GUARDIANS- Kansas requires updated physical forms and immunization forms EACH YEAR for PRE-K through Kindergarten. This means that even if you have submitted forms the previous year we will need new forms for this upcoming school year. All physicals must be dated in 2023. This applies to all NEW STUDENTS as well.

Forms to be Completed by Healtcare Provider
- 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.***
Form to be Completed by Parent / Guardian
Below is a link to complete the information needed by the school nurse including a health history, over-the-counter medication consent and consent to treat in the event of an emergency. Completing this is important so that the nurse has any pertinent health information on each student and CONSENT to obtain emergency medical care. If you have any questions please email the nurse at lhiteshew@qhrwea.org

QHR Wea Health Form

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.

**STUDENTS WITH EPI-PENS and/or inhalers – parents, please complete an Allergy Action Plan/Asthma Action Plan form. These must be completed yearly. Links to Action Plans are on the school website under “Parent Info à Health FormsàAction Plans”.
*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
Paper / PDF Forms