Health Form Requirements

  • According to The School Code of Illinois, physical examinations are required of all students prior to initial entry into school and upon entrance into sixth grade. All children entering kindergarten must submit a recent physical examination form. 

    Health Form Requirements
    Form Description Download
    Health Exam This form is required for all students who are new to District 109, as well as all students entering Kindergarten & Sixth Grade. Any child who has not returned the required documentation of a health examination will be excluded from school on October 15. In lieu of the immunization and health examination, parents may submit the: Illinois Certificate of Religious Exemption to Required Immunizations and/or Examinations Form Health Exam
    Eye Exam This form is required for all students who are new to District 109, as well as students entering Kindergarten. Documentation of the examination must be on file with the school nurse prior to October 15. Eye Exam
    Dental Exam This form is required for all students who are new to District 109, as well as students in Grades K, 2 & 6 by May 15 of that school year. The examination must have been performed within 18 months of the May 15 deadline. Dental Exam
    Permission to Administer Medication This form is for any medication (prescription or over-the-counter) to be administered at school. Medication Authorization
    Food Allergy Emergency Care Plan For children with severe allergies, an Allergy Emergency Action Plan and Treatment Authorization (e.g., Epi-Pens). Food Allergy Emergency Care Plan
    Middle School Athletic Physical (Student Athletes)

    For students entering grade 6the “Certificate of Child Health Exam” form required for all incoming students in Grade 6 can serve as the athletic physical. Make sure that your physician checks the interscholastic sports participation box. For students entering grades 7 & 8, the athletic physical form is the IESA “Pre-participation Examination” form. In any case, the physical must be less than a year old.

    Middle School Receipt of Concussion Information (Student Athletes)

    All students interested in participating in any interscholastic athletic activity must have the following forms on file with the school nurse (you only need to submit these forms once each school year)

    Interscholastic Parent Permission & Concussion Info Form
    Middle School Athletic Participation Parent Permission (Student Athletes)

    Coaches will give each team member this form, which includes fee information, student accident insurance information and asks parents to provide emergency information

    Athletic Participation Form


  • In Illinois, children enrolled in any grade need proof of up-to-date immunizations. Here are some specific requirements:

    • Students entering sixth grade must show proof of recent meningococcal conjugate vaccination (MCV).
    • Hepatitis B vaccination is required for students entering sixth grade.
    • Students must show proof of having received two doses each of live rubella and mumps virus vaccines.
    • Students entering kindergarten or sixth grade for the first time must show proof of having received two doses of varicella (chickenpox) vaccine.
    • The State of Illinois requires that all students entering grades 6, 7, and 8 provide proof of the Tdap immunization to protect against whooping cough. This immunization has been recommended for children 10 years and older for several years, and most local physicians have been including this as part of the immunization routine.

    The Illinois Department of Public Health (IDPH) provides this schedule of immunization requirements. You can visit the IDPH website for more information about immunizations.

    View the District 109 immunization summary here