CHA is a recognized school of the State of Illinois and IHSA, and all health requirements must be followed. Please complete, sign and return all health forms to CHA by the first day of school (August 27, 2018) or sooner. Questions? Contact Suzanne Karney, CHA Nurse.
Required Health Forms
- All Kindergarten Students: physical, dental and eye exams
- All Grade 2 Students: dental exam
- All Grade 6 Students: physical and dental exams
- All Grade 9 Students: physical exam
- Athletes (Grade 6-12): concussion form and physical/sports exam
- All New Preschool Students: physical exam
- All New Grade K-12 Students: physical and eye exam*
* If your student is in compliance and transferring from an Illinois school, new forms are not needed. Please have your former school include your health forms during transfer of records. If your student has a religious exemption on file for one or more immunizations, your physician will need to sign a new form for the 2018-19 school year. Thank you for completing the form prior to the first day of school.
All Health Forms and Information
Vision & Hearing Screenings – The State of IL requires certain grades to be screened for Vision and Hearing. 2018-2019 Vision & Hearing Screening will be held during school hours, Monday & Tuesday, Nov. 4 & 5, 2018.
Illinois State Physical Exam Form – (Due August 27, 2-2018) Required for all Kindergarten/Grade 6/Grade 9 students and all NEW Preschool students. New K-12 students must provide the exam from former IL school or provide a new exam.
IL State Physical Exam
Religious Exemption for Immunizations Form – (Due August 27, 2018) Required for all grades if you have an exemption for any required immunization. If your student has a religious exemption on file for one or more immunizations, your physician will need to sign a new form for the 2018-19 school year.
IL Religious Exemption Form for Immunizations (Due August 27)
Eye Exam Form
(Due August 27, 2018) Required for all Kindergarten students. New K-12 students must provide the exam from former IL school or provide a new exam.
IL Eye Exam
Dental Exam Form – (Due August 27, 2018) Required for all Kindergarten/Grade 2/Grade 6 Students
IL Dental Exam
Medication Authorization & Over the counter Medication
If you would like Health Services to have the ability to give your student a stocked over-the counter medicine (such as Tylenol or Ibuprofen) or a prescription medicine during school, we require a Medication Authorization Form signed by a doctor.
Medication Authorization Form (Required for students needing medication at school)
OTC (Over-the-Counter) Medication Form (Recommended – good for 5 years)
Severe Allergy or Medical Concern
New doctor orders will need to be submitted before Aug. 15. If your child has a severe allergy or medical concern, you must contact the school nurse so teachers can be informed before school begins. Some forms require a physician’s signature. If your student has an emergency action plan on file with Health Services due to severe allergies or medical conditions, please be sure to communicate any changes or updates for next year. For more specifics, review the Severe Allergy/Medical Concern Resource Guide (including form)
Forms Needed Annually:
Emergency Action Plan & Treatment Authorization
Medication Authorization Form not required for emergency medications that are listed in Action Plan.
Epi-Pen/Inhaler Self-Administration Permission
Forms Needed Once Per Enrollment (unless your child has a change in his/her medical condition):
Severe Allergy or Medical Concern History Form
Individual Health Care Plan
Nut-Aware Guidelines
All students and families are asked to read and follow these guidelines throughout the school year. Please note that no homemade food items may be brought for classroom/school events.
Nut-Aware Guidelines
Food List for a Nut-Aware Environment
Required Athletic Forms (Gr 6-12)
All students participating in an interscholastic sport must have a current physical exam on file before practice/try-outs begin. Students may use the IL Physical Exam or the IHSA Pre-Participation Physical Exam form. Please return all forms to the CHA (not CLA) Office. An athlete must have a current physical (within 13 month of date of exam) during the entire athletic season. A summer exam is recommended for year-long eligibility.
IHSA Consent, Asthma & Concussion Information Form (student & parent signature required)
