Required Health Forms

Some items may not be required of your child. If you have any questions, please contact the office at .

Allergy, Asthma, and Diabetes Management Plan policy form

If your child is diagnosed with an allergy, asthma, and/or diabetes, please click the link above and print the form. You and your child's Health Care Provider (HCP) must complete and sign this form. This form, along with the required documents noted within the form, must be given to the school office. If you are unable to make a copy for the child's teacher, please notify the school office and we will make a copy for the teacher.

Asthma Health Action Plan form

This form is required if your child has been diagnosed with asthma.

Certificate of Child Health Examination form

Physical examinations as prescribed by the Illinois Department of Public Health are required of all pupils any time within six months prior to their entrance into Preschool, Kindergarten, upon entrance into the 6th grade, and if a transfer student.

Generally, the family physician will complete the form although the DuPage County Health Department will perform an examination if the family meets financial eligibility requirements determined by the Health Department.

Immunizations and booster immunizations against preventable diseases are also required of all children prior to or upon entering Kindergarten and 6th grade, and prior to or upon entering any grade if the child has not been previously enrolled in a school in Illinois.

Health Examination form is due on Registration Day or no later than August 31st of the school year.

The Illinois Department of Public Health requires the following school immunizations: Measles, Mumps, Varicella, Polio, DTP/DTaP/or Td Diphtheria, Tetanus, Pertusis, Hepatitis B, Rubella, Pneumococcal Conjugate, and Lead Test.

Dental Examination form

The Illinois Department of Health requires children in Kindergarten, 2nd grade, and 6th grade to have an oral health examination. Examinations must be performed by a licensed dentist, and he/she shall sign the Proof of School Dental Examination Form. Each child is required to present proof of examination by a dentist prior to April 15th of the school year.

Diabetes Health Action Plan form

This form is required if your child has been diagnosed with diabetes.

Eye Examination form

Eye Examination – students entering Kindergarten. The eye examination form is required to be returned to school no later than October 15th of the school year.

Food Allergy & Anaphylaxis Emergency Care Plan

Illinois Certificate of Religious Exemption

This form is required per Illinois Public Act 099-0249 enacted August 3, 2015 when a parent or legal guardian requests a religious exemption from examination and/or immunization(s).

Lead Assessment Questionnaire form

All children 6 months through 6 years of age must be evaluated for lead poisoning (Illinois 410 ILCS 45/6.2).

Guidelines for Lead Risk Evaluation and Blood Lead Testing

Medication Administration Release form (prescription or over-the-counter)

This form is required for any prescription or over-the-counter medicine that will be administered during the school day. Please make sure you read and complete the form in its entirety.

If you have questions, please contact the office.