Students requiring emergency care plan(s) and/or medication(s) that need to be given during school hours will need one or more of the following forms completed.

Prior to the beginning of each school year, emergency care plans and medication authorizations should be turned in to your child's school health office and reviewed with your Licensed School Nurse.

Completed forms can be dropped off at your child's health office OR emailed to: Email Christensen. Fax: 507-789-7033

Authorization For Administration Of Medication Form Click Here

Complete the above authorization for administration of medication form if your child needs medication given during school hours.

A Health Care Provider’s signature is required for all prescription medications and for over-the-counter medications exceeding package recommendations.

*Please note that any and all medication must be brought to school by an adult in the original labeled prescription container or in unopened over-the-counter packaging. Students cannot carry their own medications to the health office.

Authorization For Administration Of Tylenol And/or Ibuprofen Form Click Here

School Health Information Form Click Here

This form should be completed for all students in Kenyon Wanamingo Public Schools grade Kindergarten, and whenever there are changes in your child's health. It is also needed for all students that are new to the district. This form should also be completed for students that are being evaluated for special education or 504 plans.

Special Diet Statement (Prek - Grade 12)Click Here

This form provides guidelines for managing a student’s food allergy/intolerance to appropriate staff members (e.g. nursing, dietary, classroom teacher(s), special areas). Required ONE time per school career, but must have a doctor and parent signature. Required to make dietary changes in hot lunch program or milk changes.

Anaphylaxis Emergency Care Plan Click Here

This form gives the school authorization to administer epinephrine(e.g. EpiPen, Auvi-Q) to a child during an anaphylactic reaction(life-threatening allergic reaction) during the school day.

Seizure Emergency Care Plan Click Here

This form should be completed for students that have a seizure disorder.

Diabetes Medical Management Plan (Dmmp) Aka Pediatric Diabetes Action Plan - Click Here (Or Provide Plan From Student's Endocrinologist)

These forms should be completed for a student with diabetes.

An Medication Physician and Parent Authorization Form or a written order signed by a physician for medications (e.g. insulin, glucagon) is also required.

Parents are responsible to bring all diabetic supplies (e.g. test strips, meter, insulin, needles, syringe, glucagon, snacks, glucose tabs, ketone strips) to the health office prior to the beginning of the school year.

Asthma Action Plans: Click Here

Asthma Action Plans need to be completed for students with asthma. This form will give authorization for asthma medications to be given at school. Asthma Action Plans can be requested from your Healthcare Provider. It is electronically signed by a physician and is good for a year from that signature date.

Authorization to Release Protected Health Information Form

Please fill out one of the authorization forms below so that the health office staff may communicate with your primary care providers/specialists to discuss health conditions as needed.

Generic Authorization Form: Click Here

Mayo Clinic Authorization: Click Here

Allina Clinic Authorization: Click Here

Northfield Hospital Authorization: Click Here

Kenyon-Wanamingo Schools

Kenyon-Wanamingo Schools