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Health Forms


Authorization for Self-Administration of Asthma Medication (if applicable)
Medical and Emergency Notification Information (All)
Certificate of Child Health Examination (PK, Kdg., 6th, new students)
Dental Examination (Kdg., 2nd, 6th)
Eye Examination (Kdg., new students to the State of Illinois)
Illinois Food Allergy Emergency Action Plan and Treatment Authorization (if applicable)
Health Concerns/Medications (all students)
Illinois Certificate of Religious Exemption (if applicable)
Medication Authorization Form  (if applicable)
OTC Medicine Authorization Form (if applicable)
Concussion Form (if applicable)
Athletics Waiver (if applicable)
If you have any questions related to health forms or issues, please contact our School Nurse, Cindy Pacewicz, BSN, RN, at


Important Info!