Health Services

Benton Central Nurse, Jen Richey, R.N./Health Center direct phone number: 765-884-3020.

Each student will need the Health Forms updated yearly, see Health Forms 2021-2022.

The following forms are not required unless they apply to your student(s) health needs:

Health Asthma Management, & Food Allergy Emergency Plan Form

Milk Substitution Form, Religious or Medical Exemption Form



Health Forms 2021-2022
Health Asthma Management Plan 21-22
Food Allergy Emergency Plan Form
2021-2022 Immunization Requirements

Each school shall require the parent of a student who has enrolled in the school to furnish, not later than the first day of school attendance, proof of the student’s immunization status, either as a written document from the health care provider who administered the immunization or documentation provided from the state immunization data registry.

(b) The statement must show, except for a student to whom Indiana Code 20-34-3-2 or Indiana Code 20-34-3-3 applies, that the student has been immunized as required under Indiana Code. The statement must include the student’s date of birth and the date of each immunization.

(c) A student may not be permitted to attend school beyond the first day of school without furnishing the documentation described in subsections (a) and (b) unless:

(1) the school gives the parent of the student a waiver;  or

(2) the local health department or a health care provider determines that the student’s immunization schedule has been delayed due to extreme circumstances and that the required immunizations will not be completed before the first day of school.

The waiver referred to in subdivision (1) may not be granted for a period that exceeds twenty (20) school days.  If subdivision (2) applies, the parent of the student shall furnish the written statement and a schedule, approved by a health care provider who is authorized to administer the immunizations or the local health department, for the completion of the remainder of the immunizations.

(d) The state department of health may commence an action against a school under IC 4-21.5-3-6 or IC 421.54 for the issuance of an order of compliance for failure to enforce this section.

(e) Neither a religious objection under IC 20-34-3-2 nor an exception for the student’s health under IC 20-34-3-3 relieves a parent from the reporting requirements under this section.

(f) The state department of health shall adopt rules under IC 4-22-2 to implement this section.

Milk Substitution Form 21-22
Religious Exemption Form 21-22
Medical Exemption 21-22