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 preschool, kindergarten and 6th grade physicals. It may also be used for sports 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 tuberculosis (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

Extracurricular Sports Forms

Sports physicals done within one year of the start of a sport season are required before participation in any extracurricular sport. An Application for Interscholastic Sports Teams (permission slip) and an 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 May 15 of each school year, every student in kindergarten, 2nd grade and 6th 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:

  1. the student presents proof of a completed dental examination
  2. the student presents proof that a dental examination will take place within 60 days after May 15
  3. the student presents a dental examination waiver form

Dental examinations for students entering preschool are strongly encouraged. Any questions regarding the dental requirements can be addressed to the school nurse.

Proof of School Dental Examination Form

Eye Examination Form

Illinois law requires that proof of an eye examination by an optometrist or physician who provides complete eye examinations be submitted to the school no later than October 15th of the year the child is first enrolled in kindergarten or enters 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:

  1. the student presents proof of a completed eye exam
  2. the student presents proof that an eye exam will take place within 60 days after October 15
  3. the student presents an eye examination waiver

State of Illinois Eye Examination Report