Physical and Immunization Form:

All students must complete this form and submit it to Health Services. NO OTHER FORM WILL BE ACCEPTED. Minor students must have the form completed by a parent or guardian.

If attending in fall form is due July 15

If attending in spring form is due November 30

MLC Physical and Immunization Form

Immunization Exemption Form – Medical and Conscientious:

A student granted a medical or conscientious exemption may be excluded from all campus activities, including classes, during a disease outbreak. The length of time a student is excluded from campus activities will vary depending on the type of disease and the circumstances surrounding the outbreak, and could range from several days to over a month. A certificate of immunization exemption for medical reasons is valid only when signed by a licensed physician, nurse practitioner, or physician assistant. A conscientious exemption is valid only when notarized.

Immunization Exemption Form MN DOH