(Click link above)

Asthma Letter

Asthma Action Plan for Home and School

Medication Consent Form

Student Immunization Record

Student Immunization Record (Spanish)

Student Health History

Varicella (Chickenpox) Information Sheet

Wisconsin Department of Health Services, Diseases and Conditions

Meningococcal Disease Information

Student Health Office Visits

Guidelines for Keeping Sick Children Home


Immunization requirements for all grade levels (4K – 12) are specified on the Student Immunization Record. If you are uncertain of your child’s status, please consult with your health care provider, or you may view your child’s record on the Wisconsin Immunization Registry (WIR); ( This is a secured computerized system for tracking immunizations given by health care providers in WI. You will be asked for identifying data in order to access your child’s record. If you have difficulty, contact your health care provider to ensure that he/she has entered your child’s identifying data into the system.

Please note the waiver information under Step 4 on the Student Immunization Record form; if you choose to waive any immunization, please complete the information under Step 4 and return to the school office.

Since schools are required to review student immunizations annually, it is helpful if you complete the Student Immunization Record when your child receives new immunizations and return to the school office.

School Nurse Contact:

Katie Breitlow

Phone: (920) 326-2431

ex. 2118