If you need assistance with completing the registration, please call Keaton at Konza Prairie Community Health Center at (785)238-4711. 

Parent/Guardian Name

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* 1. Parent/Guardian Name

Contact Information

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* 2. Contact Information

Preferred Time to Attend the Health Fair

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* 3. Preferred Time to Attend the Health Fair

Names and Date of Birth of Children Attending

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* 4. Names and Date of Birth of Children Attending

Thank you for registering your children for the 2018 Back to School Health Fair! Please bring your children's shot records with you to Konza Prairie Community Health Center at the time you selected.  See you August 4th!

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