Health Services

Forms can be returned or faxed to your child's school.

For questions, contact:
Pam Jesse, RN
District Nurse
(262) 789-6439
(262) 789-6261 (Fax)

Click on a form below to download. Requires Adobe Acrobat Reader to open.

Immunization Information

Waukesha County Immunization Clinics
Wisconsin Immunization Registry
2011-2012 School Year Immunization Facts
2011-2012 Student Immunization Record
Meningitis Fact Sheet
Meningitis Letter for Parents
2012-2013 School Year Immunization Facts
2012-2013 Student Immunization Record

H1N1 Flu Information

A Guide for Parents - Seasonal & H1N1 Flu
Posted 10/20/09
Stop Germs at Home

Health Information

When to Keep Your Child at Home
Treat Guidelines / Peanut Allergies
Medication Policy

Medical Forms

Asthma Health Care Form
Allergy Health Care Form
Authorization for the Administration of Non Prescription Medicine
Authorization for the Administration of Prescription Medicine
Emergency Illness Form
School Dental Referral Form
Student Health Examination Form
Requested for students entering grades K, 5, 9

Lice Information

S.C.R.A.T.C.H Slideshow
Fact sheet

School Fax Numbers

Elmwood Elementary
(414) 427-7290
Glen Park Elementary
(262) 789-6206
Orchard Lane Elementary
(262) 789-6286
Poplar Creek Elementary
(262) 789-6234
Ronald Reagan Elementary
(262) 789-6205
Eisenhower Middle & High
(262) 789-6313
New Berlin West Middle & High
(262) 789-6442

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