Jackie Bolas
[email protected]
Office Phone: 402.332.3048
Office Fax: 402.408.2536

Medical Forms

Physician/Parent Medication Permission Request Form

Student Asthma/Allergy Action Plan

Self Management Asthma/Allergy Form

Nurses Notes

March 16, 2021

Dear Parents/Guardians,

Nebraska State Law directs each school to require evidence of a physical examination by a qualified physician within six months prior to the entrance of a student into the seventh grade. Please include a copy of the physical from your doctor’s office.

If your son/daughter is considering participating in any middle school sport, the physical exam must be done after May 1st. Students may not participate in any sports practice or game until the physical form is completed and returned to school.

Every student will need to have a booster immunization containing diphtheria and tetanus toxoids and an acellular pertussis (Tdap). This immunization is a state requirement and needs to be completed in order to start school in the fall.

If there are medical or religious reasons for your son/daughter not to receive the immunizations, there is a waiver form available to sign upon request.

If you have any questions, please call Gretna Middle School at 402-332-3048.


Jackie Bolas, RN
Gretna Middle School Nurse
[email protected]