Version: Combined English/Spanish

A new preschooler, kindergarten student, or first through fifth grader entering a public school for the first time must furnish a physical examination / School Health Entrance Form (MCH 213) performed NO EARLIER than twelve months prior to the date of attending school. This physical exam is to include all components as stated on the MCH 213. A signed Certificate of Immunization (part 2 of MCH 213) must be present PRIOR to entry.

Version: Fillable form

Student health information form filled out by parent to provide information to the school health nurse. 

Form to be completed by parent/guardian. Student may require TB skin test based upon answers to questions.