School District of Poynette

Health Forms for Students

Following is a collection of documents and forms that must be completed and submitted for various grade levels and students new to our district. Print and complete the forms relevant to your child and submit them to the school nurse.

Headache/Migraine Treatment Plan

Bowel Management Plan

Asthma Treatment Plan

Allergy Treatment Plan

Health History Form

Medical Procedure Authorization

Authorization to Administer Medication-Child Care

This form provides authorization to administer medication for the four year old preschool student.

Child Health Report-Child Care Centers

Students in our four-year-old preschool program must submit this report to our school nurse.

Day Care Immunization Record

Four year old preschool students must return this form to our school nurse.

Student Vision & Eye Health Exam Report

Kindergarten students must submit this report detailing their vision and eye health exam.

Physical Exam Report

The Health Care Provider Report of Physical Examination must be submitted for new students of all grade levels.

Student Immunization Record

This immunization record must be completed for students at any grade level.

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School District of Poynette
108 N Cleveland Street, Poynette, WI 53955
Phone: 608-635-4347 | Fax: 608-635-9200
Email