Medical Forms

Child Exam Health Form Dental Form Eye Exam Health Form Requirements Health Form Requirements: New to Illinois Health Form Requirements: 2nd Grade Health Form Requirements: 6th Grade

Sports Physical & Concussion Form Dental Exam Waiver Health Form Requirements: Pre-K Health Form Requirements: New to the U.S. Understanding Type 1 Diabetes for Parents and Guardians

School Medication Form Eye Exam Wavier Health Form Requirements: Kindergarten Health Form Requirements: Transfer Students

 

Dear Parents or Guardian:

A current health examination and proof of immunizations is required for all students entering Pre-K, Kindergarten and 6th Grade (dated within 1 year of the first day of attendance for the current school year.) If your child is new to Pennoyer, but has previously attended school in Illinois, the health examination record must be obtained from the previous school and provided to Pennoyer on or before August 25, 2025 for the upcoming 2025/2026 school year. Additionally, An eye examination is required by the State of Illinois for all Kindergarten students and must be turned in to Pennoyer Health Office, on or before October 15, 2025. A dental examination is required by the State of Illinois for all students in kindergarten, 2nd, and 6th grade and must be turned in on or before May 15, 2026.

If your child is new to Pennoyer and previously attended school outside of Illinois, A current health examination must be completed by an Illinois physician, No later than August 25, 2025, for the upcoming 2025/2026 school year. Additionally, an eye examination by an optometrist or a physician who provides complete eye examinations must be turned in to Pennoyer Health Office, on or before October 15, 2025.

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:

●  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

●  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.

For an easy to read, more detailed list of requirements by grade, please visit our website at the following URL

https://www.pennoyerschool.org/parentsstudents/medical-forms

Sincerely,

Alana Cardenas, BSN, RN School Nurse
Pennoyer Health Office alanac@pennoyerschool.org

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Additional Health Resources

Pediculosis (Lice) Information for Parents: "Once a Week Take a Peek"

Children without insurance:
https://www.illinois.gov/hfs/MedicalPrograms/AllKids/Pages/about.aspx