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ME - Student Health Information
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Email
*
Your email
Student Last Name
*
Your answer
Student First Name
*
Your answer
Student Grade
*
Your answer
KORT Teacher
Your answer
Does your child have any health problems (ex Asthma, Allergies, Diabetes, Heart Condition, Seizures, ADHD, Depression, Anxiety, etc.)?
Your answer
Is your child taking any medication at home? If yes, please list medications here.
Your answer
Will your child be taking any medication at school? If yes, please complete and sign a Medication Authorization Form (available on the Health Services page of our school district's website) or call the School Nurse at 763-497-6555.
Yes
No
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Does your child have any allergies? If yes, please list them here. SCHOOL LUNCH -- If your child will be eating School Lunch and has food allergies that are life threatening, please call Delores Helgeson, Food Service Director, at 763-497-6537 prior to eating School Lunch.
Your answer
Has an Epi Pen been prescribed for your child's allergy?
Yes
No
N/A
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Has your child been hospitalized, had any operations, and/or had any serious injuries in the past year? If yes, please list the date(s) and reason(s)/injuries.
Your answer
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