Kansas Department of Health & Environment Forms

This Form is used for documenting and obtaining consent for vaccines in the state of Kansas.

This Form is used for reporting incidents in the state of Kansas. It is used to document and provide details about incidents such as accidents, injuries, property damage, or other related incidents.

This Form is used for obtaining an agreement between the user and the Wic Program in Kansas for the use of breastfeeding equipment.

This form is used for applying to the Head Start/Early Head Start program in Kansas. It collects information about the child or pregnant mother.

This form is used for authorizing the dispensing of long-term medications (both prescription and non-prescription) to children and youth in Kansas. It is available in both English and Spanish.

This form is used for obtaining parental permission for off-premise trips in Kansas. It is available in both English and Spanish.

This Formulario is used for parents to give permission for their children to go on excursions outside of the facility in Kansas.

This Form is used for requesting verification of child abuse registration for daycares and residential care centers in Kansas.

This form is used for notifying the state of Kansas about any injury, illness, or critical incident that occurs. It helps in reporting and documenting such incidents for official purposes.

This form is used for obtaining authorization to dispense short-term medications, both prescription and non-prescription, to children or youth in Kansas. The form is available in English and Spanish.

This form is used for orienting new employees in child care centers or preschools in Kansas. It helps ensure that all necessary information and procedures are covered during the orientation process.

This Form is used for making an inquiry about the licensure of a Child Care Center, Preschool, or Mother's Day Out program in Kansas.

This form is used for verifying the health status of individuals aged 14 and above who are working or volunteering in school age programs in Kansas.

This form is used for claiming mileage expenses in the state of Kansas. Fill out this form to request reimbursement for travel expenses incurred while using your personal vehicle for work purposes.

This form is used for inquiring about the licensure of a school-age or drop-in program in Kansas.

This form is used for orientation checklists for long-term care homes and community homes in Kansas.

This form is used for collecting the medical records of all children in child care facilities in Kansas, including the provider's own children.

This document is used for reporting immunizations in the state of Kansas. It is a form that provides information about a person's immunization records.

This form is used to notify the Kansas State Government of a change in program director.