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District Health Expectations and Forms

State of Illinois Health Requirements for 2023-24 School Year

Health Forms and Grade Level which they are needed


Early Childhood Physical Form (Both Pages)
Kindergarten Physical Form (Both Pages)
Eye Examination Form
Dental Examination Form
2nd Grade Dental Examination Form
6th Grade Physical Form (Both Pages)
Dental Examination Form
9th Grade Physical Form (Both Pages)
Dental Examination Form
12th Grade Proof of 1 Meningitis Shot after 16th birthday

Pre-Participation Examination Form
or Physical Form (Back Page)


New to Our District 
All Forms Needed
Physical Form (both pages), Eye Examination Form,
and Dental Examination Form 
HIPAA-Compliant Authorization Release of Health Information Form


Medication that is Needed at School
Documentation from the Doctor is Required 

Administer Medication Form

Inhaler needed at School 
Asthma Action Plan Form (All Pages)

Epi Pen Plan /  Allergies 
Allergy Emergency Action Plan and Treatment Authorization Form (All Pages)

Food Substitution Form (Required)
Physician Statement for Food Substitution

Religious Exemption Form
Physician Statement for Required Immunizations

for Families

COVID-19 Guidelines and Safety Procedures

Flu Guide for Parents

Any Questions
Please Do Not Hesitate to Call Your Student's School Nurse!

* Updated March 11, 2024