School Health

School Health Forms

Emergency Health Plans
If your child has a health condition that may require emergency treatment at school, please fill out an Emergency Health Plan for the condition listed below. If you do not see your child's specific condition or feel the health plan is not what you would like followed at school, please contact your school nurse.

Asthma (English/Spanish)
Severe Allergy (English/Spanish)
Seizure (English/Spanish)

Health History Forms
If your child has a health condition, health history forms help the school nurse in provide the best care for your child. Please fill out the below forms if applicable to your child's health condition.

Diabetes Medical Management Form
Allergic Reaction History Form
Seizure Health History Form

Medication Consent Form
Administration of medication requires both the signature of a parent and the physician on the consent form. A new consent form is required each time a medication or dosage is changed.

Medication Administration Guidelines-English
Medication Administration Form-English

Medication Administration Guidelines-Spanish
Medication Administration Form-Spanish

Immunization Forms
State law requires all public and private school students to present written evidence of immunization against certain diseases within 30 days of admission. 

Student Immunization Form-English
Student Immunization Form-Spanish

Health Department
Menasha City Center
100 Main Street, Suite 100
Menasha, WI 54952

Phone: 920-967-3520

Office Hours:
Monday - Friday
8:00 am - 4:00 pm