Forms Required for Elementary Students

District Physical Assessment Form(revised 02/21/24)

Physical required for children entering Pre-K, KG and ALL new Out-of-State students. Must be performed within past 12 months & signed by licensed physician, RPA, ARNP or RN certified to perform health assessments.

Immunization Form-Kansas Certificate of Immunizations

(KCI)

KCI must be completed by physician or health department. Must be up-to-date on immunizations prior to entering school. For Pre-K, KG and New Students.

Immunization Requirements for 2024-2025

State requirements for enrollment.

Birth Certificates
For Kansas application:
www.vitalchek.com

Required for school entry.

Forms Required for LMS & LHS Students

24-25 KSHSAA Sports Physical Forms

LHS Forms

LMS Forms

Please complete this physical form for your 24-25 school year. 

Must be completed for students participating in sports, cheerleading and drill team, prior to try-outs &/or practice.  Must be signed AFTER May 1st for following year.

Physical Assessment Form

Physical required for ALL new Out-of-State students enrolling for the first time. Must be from licensed physician within the past 12 months.  Sports Physical Form above can take the place of this document for enrollment ONLY if signed by licensed physician, RPA, ARNP or RN certified to perform health assessments..

Louisburg Elementary Wellness Policies

Forms for Student Special Health Needs

District Authorization of Medication at School Form

Prescription medications must be brought to school by a parent. The medication must come to school in the current prescription bottle with your child's name, name of the medication, amount of medication to be given, and time it should be given. You may ask the pharmacist to divide the medication into a bottle for home and one for school.

Kansas Asthma Action Plan

If your child has asthma, Kansas law requires that your child have a care plan completed by your child’s physician.

Allergy & Anaphylaxis Emergency Plan   (food, stings, etc. needing epinephrine)

Required by law for children with life-threatening allergies.  Plan needs to be completed by physician for treatment of possible reaction.

Meal Food Modification Form

Medical Statement for Student Requiring Special Meals

Special dietary needs cannot be accommodated until plan completed by doctor provides a list of foods students must omit from diet and a list of approved substitutions, including milk and peanut butter.

Seizure Care Plan

If your child has a seizure disorder, the doctor must complete a seizure care plan.

Diabetes Care Plan

If your child has a diabetes, the doctor must complete a seizure care plan.

Health Insurance Info - KanCare

www.kancare.ks.gov

Children's health insurance assistance through KanCare.

District Authorization of Medication at School Form

District Parent Release for Action Plans