Forms

Medication Authorization

Please fill out if your student will need to take medication at school. 

• If more than one medication taken, fill out separate forms for EACH medication

• If this medication is a prescription medication, we MUST have a medical order and physician signature before we can accept or administer the medication.

  • We are able to fax copies of the authorization to medical providers if we have  a signed release of information.

• Authorizations are good for the current school year only. New forms must be filled out for each new school year.

Release of Information

Please fill out if you would like the Health Office to communicate with your student's medical providers. 

• Please indicate who the Health Office may share or request information with.

• Release of Information is good for the current school year only. New forms must be filled out for each new school year.

Health Information Form

Must be filled out at the beginning of each school year so that the Health Office is aware of on-going and/or new health concerns that Zumbro Education Students may have. 

Immunization Forms

These forms are helpful for knowing which immunizations are due at certain ages.  The back page of this form must be filled out and notarized by a Notary Public if you choose NOT to immunize per the MN Department of Health's requirements.