Health Requirements & Forms
Certificate of Child Health Examination
The Certificate of Child Health Examination is the form that your physician must use to record the required pre-school, Kindergarten, and 6th grade physicals.
Your doctor must fill in ALL of the required sections, including the Diabetes Screening. Lead screening is required for children six years of age and under. Screening for TB is also strongly recommended. Parents must fill out the Health History section of the form.
Certificate of Child Health Examination Form
List of Immunization Requirements 2022/2023
Extra-Curricular Sports Forms
Sports physicals done within one year of the start of the sport, are required before participation in any extra-curricular sport. An “Application for Interscholastic Sports Teams” (permission slip) and “Authorization for Emergency Medical Services” must be turned in with the sports physical before the student can practice or compete in any sport.
Please note that the Illinois Elementary School Association mandates the following:
3.061 No student shall be permitted to compete in a try-out, practice, or game unless such student has filed with the school principal a certificate of physical fitness issued by a licensed physician, physician’s assistant, or nurse practitioner as set forth in the Illinois State Statutes not more than 395 days preceding such tryout, practice, or contest in any athletic activity.
3.062 No student shall be allowed to participate following disabling illness or injury without a physician's release
IESA Pre-participation Examination
Consent for Participation on Interscholastic Sports Teams Form
Authorization for Emergency Medical Services
Concussion Acknowledgement and Consent Form
Proof of School Dental Examination
By the 15th of May of each school year, every student in Kindergarten, Second, and Sixth Grade must present to the school proof of having been examined by a dentist. If proof is not submitted, the school may hold the student's report card until one of the following occurs:
the student presents proof of a completed dental examination
the student presents proof that a dental examination will take place within 60 days after May 15th
the student presents a dental examination waiver form
Dental examinations for students entering Pre-School are still strongly encouraged. Any questions regarding the dental requirements can be addressed to the school nurse.
Proof of School Dental Examination Form
Dental Examination Waiver Form
Eye Examination Form
Illinois law requires that proof of an eye examination by an optometrist or physician who provides complete eye examination be submitted to the school no later than October 15th of the year the child is first enrolled in Kindergarten or entering an Illinois school for the first time. If proof of examination is not submitted, the school may hold the child's report card until one of the following occurs:
- the student presents proof of a completed eye exam
- the student presents proof that an eye exam will take place within 60 days after October 15th
- the student presents an eye examination waiver
State of Illinois Eye Examination Report
Eye Examination Waiver Form
Ms. Kelly Borgardt RN
708 867-5822 x128
Health Quick Forms:
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