z-Boarding APP-Student Health Information

    Youth Initiative High School
    Boarding Student Application for Admission

    Student Health Information

    Insurance Information

    Youth Initiative High School requires all students with Health Insurance to submit proof of insurance with relevant contact information to YIHS staff.
    Local Emergency Contact Information ( if you do not have a host family yet, leave this blank):

    Health Information:




    We are required by law to keep all student’s vaccination records on file.
    Domestic Boarding Students:
    Download, fill out, and return this required form before student arrives at YIHS.
    http://www.dhs.wisconsin.gov/forms/F0/F04020L.pdf
    International Boarding Students:
    After we receive your application, we will send you an immunization form.  This form must be filled out and returned before student can attend YIHS.


    I hereby give my consent for EMERGENCY MEDICAL CARE OR TREATMENT