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Health Screening Opt-out

Required

HMS
Health Screening Opt-out

Student Namerequired
First Name
Last Name

I, the undersigned, being the parent or legal guardian of the student named above, hereby acknowledge that Liberty Public Schools (LPS) provides routine health screenings as part of its student health services program to identify potential barriers to learning.

I am formally electing to opt-out of the following district-offered health screenings.required
A typed signature on this form is legally equivalent to a handwritten signature.
Must contain a date in MM/DD/YYYY format

Please complete the security verification below.

LPS Health Services Information

Additional forms for asthma, allergies, seizures can be found within resources below.

LPS Health Forms

LPS Health Services

Clay County Immunization Information