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Health Forms


Authorization for Self-Administration of Asthma Medication (if applicable)
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)
Medical and Emergency Notification Information Authorization (all students)
OTC Medicine Authorization Form (if applicable)
If you have any questions related to health forms or issues, please contact our School Nurse, Cindy Pacewicz, BSN, RN, at


Extended Day