Health Related Forms and Waivers

REQUIREMENTS PER GRADE:

Kindergarten:
Physical.  DUE by Oct. 15.
Official Birth Certificate (not hospital).  MUST be submitted at time of registration unless there is a special circumstance approved by an Administrator (new foster child, etc) 
Vision (exam or waiver)  DUE by Oct. 15.
Dental (exam or waiver)  DUE by Oct. 15.

2nd grade:
Dental (exam or waiver).  DUE prior to May 15.

6th grade:
Physical.  Due by Oct 15.
Dental (exam or waiver).  DUE prior to May 15.

School Physicals

The “State of Illinois; Certificate of Child Health Examination” form is required for students entering grades Kindergarten, 6th, 9th.  It is also required for students enrolling for the first time in an Illinois school, regardless of the grade.

Immunizations must be documented on the front page of the physical and up-to-date.  The parent part must be completed by the parent / guardian prior to turning in the form to the school nurse.

A chiropractor is not authorized to perform a school physical or sign the form.

Failure to provide a completed Illinois physical with up-to-date immunizations by either Oct. 15, or a date identified by the district, will result in the student being excluded from school until the verification is presented.


Sports Physicals

No student shall be permitted to compete in a tryout, practice, or contest unless the student has a completed school physical by a licensed physician, physician’s assistant, or nurse practitioner not more than 395 days preceding such tryout, practice, or contest in any athletic activity.


Self Administration Asthma Form

Needs completed yearly.  The prescription label must be with the inhaler.

Please provide an Asthma Action Plan to the school nurse every school year if your student has asthma.  An example is provided


Medication Authorization Form

Needs completed yearly, and with any medication change.  Must be completed and signed by the doctor and parent prior to medications given at school.


Vision Exam Forms

Proof of an eye exam by an eye doctor must be turned into the school no later than October 15 for students who are enrolled in an Illinois school for the first time.  If unable to complete the eye exam, a waiver form must be turned in to the school.

The waiver is required if the parent / guardian of a child who is enrolling in an Illinois school for the first time is unable to complete the above “eye exam form.”  The waiver must be turned into the school by October 15.


Dental Exam Forms

All students in Kindergarten, 2nd and 6th grades are required to have an oral health exam by a dentist.  The dental exam form must be turned into the school prior to May 15 of the effective school year.  If unable to complete the dental exam, then a waiver must be completed and turned into the school.

If a parent / guardian is unable to complete the dental exam requirement by May 15, then a waiver must be completed and turned into the school by May 15.


Food Allergy Form

The Food Allergy Emergency Action Plan must be completed by both the parent / guardian AND physician for students with food allergies.  Emergency medications as ordered by the physician should be provided to the school.


Religious Exemption to Required Immunizations and/or Exam Form

This form must be used by parents / guardians who are requesting a religious exemption to immunizations or exams for their student in Kindergarten, sixth, or ninth grades, or if the student is new to the district.  Consult with the school nurse for specific information pertaining to the form. PLEASE NOTE:  for the health and well-being of the student, he/ she may LEGALLY be excluded from school during a disease outbreak of a vaccine-preventable disease if your child was not immunized against that illness.