Medical Forms

2016-2017 School Year Medical Information

Dear Parents or Guardian,

As required by the Illinois Health and Physical Education Law, a current health examination and proof of immunizations is required for all students entering Kindergarten and 6th Grade. If your child is a new student and has previously attended school in Illinois, the health examination record must be obtained from the previous school. If your child is new and attended school outside of Illinois, an eye examination by an optometrist or a physician who provides complete eye examinations AND a current health examination must be completed by an Illinois physician before your child's first day of school.

An eye examination is required by the state of Illinois for all Kindergarten students and must be turned in by October 15, 2016.

A dental examination is required by the state of Illinois for all students in kindergarten, 2nd, and 6th grade and must be turned in by May 15, 2017.

All students must comply with the rules and regulations for immunizing school children pursuant to the School Code and must present evidence of immunity against:

  • Tuberculin Test- Required: date and result.
  • Combined Measles, Mumps, and Rubella (MMR) - 2 doses with the first dose at 12 months of age or older.
  • Polio- 4 doses, with the LAST DOSE AT 4 YEARS OF AGE OR OLDER.
  • Diphtheria, Tetanus, Pertussis- 5 doses with the LAST DOSE AT 4 YEARS OF AGE OR OLDER.  The state of Illinois has mandated that all 6th, 7th and 8th grade students show proof of having received 1 dose of Tdap (tetanus, diphtheria, acellular pertussis) regardless of the interval since the last DTaP, DT or Td dose.
  • 6th Grade – Meningitis, 1 dose required  
  • Diabetes Screening- Required in order to begin Kindergarten and for all 6th grade students.
  • Lead Screening- All children ages 6 or under are to present evidence of Lead Screening, however, your child will not be denied entrance to school if noncompliant.
  • Hepatitis B- All 3 shots must be completed upon entrance to 6th Grade.
  • Varicella (chicken pox) – 2 doses with the first dose at 12 months of age or older.

If for any reason immunization cannot be brought up to date prior to the school opening date, a note of intent must be signed by the physician that your child has begun or will begin the necessary immunization procedures.

All Health Examination forms with proof of immunizations must be turned in to the school on or before the first day of school. Your child must be excluded from school if the above requirements are not met.

Please call if you have any questions.

Thank you,

Gina Sierra

School Principal