Washington State form used by parent/guardian to report immunization information for their student. See Washington State requirements
for school attendance. Some students (e.g., kindergarten, 6th grade) may need to complete the immunization requirements after registration and before the start of school.
Exemptions require both parent/guardian and health-care provider's signature except for certain religious exemptions.
Information provided by the parent/guardian alerting the school nurse to health issues. This form may be requested by the school each school year in order to keep current with your child's health information.
Gives Steilacoom Historical School District and health care provider, hospital, or clinic permission to exchange information about a student
State or federal law requires that a form must be completed and signed by both parent/guardian and a licensed health care provider with prescriptive authority for ALL medications to be given at school, including over-the-counter (OTC) medications. This form needs to be renewed at the beginning of each year.
Life-Threatening Health Conditions
Washington State law requires that when there is a student with a known life-threatening condition schools must be prepared for a life-threatening event on the day the student starts school. This would include the necessary forms from the health care provider as well as needed medications. These documents need to provide current information and should be prepared after July 1 for the following school year.
Diet Prescription for Meals at School
Health-care provider must complete and sign that the student needs a special school meals prepared or served because of the student's disability or chronic medical condition.
Students with Diabetes
Please call the Health Services Coordinator to discuss the needs of your student. These documents need to provide current information and should be prepared after July 1 for the following school year.