Required Health Forms


From immunizations to physical examinations, student health is an important school and community preparedness issue. Listed to the right 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.  

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. Swanson, at 654-3317 ext. 128.

Below is a description/explanation of some of the forms.

Application for Certified Copy of Birth Certificate

Prior to attending school, all students will need to provide a certified copy of their birth certificate.

Physical Examination/Vision Requirements

Physical examinations are required of 

    • 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

 For this form the School Vision Evaluation is included in the Physical Examination form.  A School Vision Evaluation is required for all children within six months prior to entering Nebraska schools for the first time.

In addition, you will find Health History forms listed below the Physical Examination form.  These will need to be turned in for the appropriate age level.

Parental Request for In-School Medication

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.

Summary of School Immunization Rules & Regulations

Specific immunizations are associated with specific ages. Please, review regulations carefully. The Three Rivers Health Department sponsors an immunization clinic. However, you will need to call ahead for an appointment at 402-727-5396 or toll-free 866-727-5396.

Three Rivers District Health Department
2400 N. Lincoln Ave.

Fremont, NE 68025