The required health forms shown below are due to CHA by the first day of school, August 16, 2021, for all students entering Grade 6. Please email the forms as attachments to Health Services with a subject line as follows: Health Forms – Last Name, First Name (for example: Health Forms – Doe, Susie)


◘ Updated Physical Exam
  • Physical exam certificates must be dated no more than one year prior to the first day of school. If your student’s physical exam certificate is not received by CHA by October 15, he/she will be excluded from school according to Illinois School Code.
  • To be considered valid,  ALL three sections of your student’s Physical Exam Certificate must be completed and signed as follows:
  1. Health History (top section page 2) Completed, dated, and signed by parent
  2. Physical exam completed and signed by physician/practitioner – Note: There is a box the doctor can mark on this form giving clearance for students to participate in sports
  3. Immunization record completed and signed by physician or nurse – Must include documentation of Meningitis vaccine and Tdap vaccine. For information regarding immunizations, please refer to the Health Services page for the State of Illinois Immunization Requirements. (If your student does not receive immunizations, you must complete the Illinois Religious Exemption Form for Immunization found on the Health Services page. A new letter must be submitted each school year.)
◘ Dental Exam Form
  • Dental exam forms dated after November 15, 2020, will be accepted. If exam is not in student’s file by 5/15/22, he/she will be excluded from school.
  • Have your dentist sign and date the form.
◘ Athletic Forms
  • Athletic forms are required only if your student will be participating in school sports, but must be submitted before student even attends a practice or conditioning.
  • Full details are on the Required Health Forms – Athletics page.
◘ Religious Exemption Form for Immunizations (optional)
  • If you are claiming religious exemption for any required immunizations, you must submit a new Illinois Religious Exemption Form for Immunizations before beginning Grade 6.

Find links to all forms on the main Health Services page. You may wish to print this page out so you know which forms are needed for your student.

Special Medical Conditions and Other Health Forms

If your student has a special medical condition that we should be aware of, and/or would like them to be able to receive prescription or over-the counter medication as needed, authorization forms are required. Information on the following health items, and their related forms, are available on the Health Services page via the Special Medical Conditions button:

  • Allergies
  • Emergency action plans
  • Prescription Medication Authorization
  • Over-the-counter (OTC) Medication Authorization (such as Tylenol, Benadryl, etc.)
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