Common Forms
Dental Examination Waiver
Eye Exam Waiver
Food Allergy Management Program
IHSA Health Form
Home and Hospital Services
Proof of Dental Exam
Request for Administration of Medication
Self Administration of Asthma or Epinephrine
State of Illinois Eye Exam Report
Student Physical Form

K, 6^th, & 9^th Graders:  Need a physical and required immunizations in order to enroll.

Middle School & High School:  Schedules cannot be picked up until physicals with updated immunizations are turned into the school.

Freshmen Physical Forms - All first year freshmen must have a completed physical form to register.  Students that do not have their physical form will not be allowed to pick up their school schedules.

• Freshmen: 9th grade physical and proof of 2 varicella vaccines. Proof of Tdap.
• Sophomores: Varicella - proof of 2 varicella vaccines
• Juniors:  Varicella - proof of 2 varicella vaccines
• Seniors: Proof of one meningococcal vaccine after 16th birthday.
• All High School Students EXCEPT Seniors: Proof of 2 varicella (chickenpox) vaccines.
• All new students to the state of Illinois needs an Illinois school physical

Students entering 6th or 12th grade 

6th Graders:  1 dose of MCV4 at school entry.
12th Graders:  2 doses of MCV4 at school entry; 2nd dose must be administered on or after 16th birthday.

Minimum Intervals Allowed Between Doses and Other Options for Proof of Immunity

The 1st dose received on or after the 11th birthday, and the 2nd dose received, on or after the 16th birthday, at least eight weeks after the 1st dose. If the 1st dose is received at 16 years of age or older, only 1 dose is required.