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Health Forms (Printable)

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Important State of Illinois Health Requirements

School Year 2017-18

 

Kindergarten

The following examinations are required for entrance into Kindergarten:

  1. Physical Examination (within 1 year of the 1st day of school)—This must be documented on the State of IL Child Health Examination form.  Please make sure that you have filled out the Health History section on this form or it will be returned to you.  These forms are due on/before the 1st day of school.

 

  1. Immunization record—This should be written on the above form or a copy of the immunizations from the physician’s office will be accepted.  Required immunizations for incoming Kindergartners are as follows: (In accordance with the IL Child Health Examination Code Section 665.240)
  • DTaP—4 or more doses
  • Polio (IPV)—4 or more doses
  • Varicella—2 doses
  • MMR (Measles, Mumps, Rubella)—2 doses

 

  1. Vision Examination—This exam is to be submitted no later than October 15th of the current school year.

 

  1. Dental Examination—This exam is to be submitted no later than May 15th of the current school year.  Dental exams must be dated within 18 months of the May 15th deadline.

 

2nd Grade

  • A dental examination is required for all 2nd grade students by May 15th of the current school year.  Dental exams must be dated within 18 months of the May 15th deadline.

 

 

6th Grade

The following examinations are required for entrance into 6th grade:

  1. Physical Examination (within 1 year of first day of school)—This must be documented on the State of IL Child Health Examination form.  Please make sure that you have filled out the Health History section on this form or it will be returned to you.  These forms are due on/before the 1st day of school.

 

  1. Immunization record—This should be written on the above form or a copy of the immunizations from the physician’s office will be accepted.  Required immunizations for incoming 6th graders are as follows: (In accordance with the IL Child Health Examination Code Section 665.240)
  • Tdap—1 dose
  • Polio(IPV)—3 or more doses
  • Hepatitis B—3 doses
  • Varicella—2 doses
  • MMR (Measles, Mumps, Rubella)—2 doses
  • Meningococcal Conjugate (Meningitis)—1 dose on/after 10th birthday

 

  1. Dental Examination—This exam is to be submitted no later than May 15th of the current school year.  Dental exams must be dated within 18 months of the May 15th deadline.

 

9th Grade

 

The following items are required for entrance into 9th grade:

 

  1.  Physical Examination (within 1 year of the 1st day of school)--This must be documented on the State of IL Child Health Examination form.  Please make sure that you have filled out the Health History section on this form or it will be returned to you.  These forms are due on/before the 1st day of school.

 

  1.  Immunization record---This should be written on the above form or a copy of the immunizations from the physician’s office will be accepted.  Required immunizations for incoming 9th graders are as follows: (In accordance with the IL Child Health Examination Code Section 665.240)
  • Tdap—1 dose
  • Polio (IPV)—3 or more doses
  • Varicella—2 doses
  • MMR (Measles, Mumps, Rubella)—2 doses

 

12th Grade

 

  • The Meningococcal Conjugate Vaccine (MCV4/Meningitis) is required for entrance into 12th grade.  You must show proof of receiving 2 doses of MCV4 with the second dose being administered on/after your 16th birthday.  If the 1st dose of MCV4 was administered on/after your 16th birthday, then only 1 dose of MCV4 is required at 12th grade entry.

 

 

 

Transfer in from “out of state” students

 

The following examinations are required for entrance into school:

  1. Physical Examination—This is required for all students entering Illinois.  This exam must be documented on the State of IL Child Examination Form.  In addition, an immunization record from the physician must be written on the above form or a copy provided.  These are to be submitted within 30 days of the first day of school.
  2. Vision Examination—This is required for any student entering an IL school for the first time at any grade.  This is to be submitted no later than October 15th of the current school year.

 

Printable Forms

Dental Form  

Eye Exam

Physical Form

Sports Physical Form

‚ÄčMedication Authorization Form