Please save the form above to your computer or device. Complete them by clicking on each field (or tapping the "tab" key to move between fields), then save to your computer or device. Be sure to open them and check that they have your typed info saved, then return them to the Manton Adolescent Wellness Center via email: email@example.com or you may print and send back to the school with your child. This will ensure that they safely and confidentially arrive to the clinic.
Manton and Mesick School Nurse
105 5th Street, Manton, MI 49663
1 (231) 306-3010