Downloadable Forms


Illinois state law requires all students entering Preschool for the first time, Kindergarten, 6th grade and new students to the State of Illinois are required to have a current physical and be up to date on required immunizations. All health and emergency forms must be on file in the health office prior to the 1st day of school. If forms are not turned in child/children will not be able to attend. The primary goal of the health office is the safety and well being of all students. September 15th all physicals and immunization records for required students are due. Including kindergarten eye exams.May 15th all dental forms for grades K, 2, 6th are due.

  • Physical exam signed and dated by doctor
  • Immunizations signed and dated by health care provider
  • Medical history filled out and signed by parent/guardian
  • Mandatory Diabetes Risk Assessment
  • Lead Screening for children 6 years and under
  • Forms must say Rev 02/13 or Approved SHP with date if electronic

Eye exam

All children entering Kindergarten and any student enrolling for the first time in Illinois are required to have an eye exam.  The eye exam requirement does not apply to children enrolling in preschool.  Examinations must be performed by a licensed optometrist or medical doctor who performs eye exams.

Proof of exams are due to the school office by September 15th.  The required eye exam must be completed within one year prior to the first day of the school year in which the child enters Kindergarten or the child enters the Illinois school system for the first time.  If unable to obtain the required vision exam, students must have a waiver signed by a parent/guardian prior to start of school.

Dental Exam

All children entering Kindergarten, 2nd and 6th grade are required to have an oral health examination.

Examinations must be performed by a licensed dentist, and he/she must sign the proof of school dental exam form.  Each child is required to present proof of exam by a dentist, or have a waiver signed by a parent/guardian, prior to May 15th of the current school year.  School dental exams must have been completed within the 18 months prior to the May 15th deadline.

Student Illness

  • The child must be kept at home if any of the following symptoms exist
    • Nausea, Vomiting or Diarrhea
    • Excessive Coughing or Sneezing
    • Fever of 100 degrees or higher
    • Inflamed, swollen, reddened, or watery eyes
    • Severe Headache/Earache
    • Unexplained rash or sore

Students must be fever, vomit or diarrhea free for 24 hours without fever reducing medications before returning to school.

  • Parents will be notified by the school health care provider if their child becomes ill during the school day and will be expected to make arrangements to have them picked within 1 hour.
  • It is imperative that every family have an additional emergency contact that will be available to pick up a sick child from school.
  • The parent shall notify the school of any cases of communicable disease.
  • A student must be called in every day. If a student is absent for 3 or more days, a doctor’s note is required for readmittance to school.

Students are expected to make up all class work when they have been absent from school due to illness.  It is wise to keep in contact with teachers and request that work be sent home once children are well enough to work on assignments. Students will have the same number of days to make up their work as they were absent.


  • Concussion Policy
  • If a student is injured and needs to be excused from Physical Education, athletics, or additional school activities for a WEEK or less, a parents note is required.
  • If a student is injured and needs to be excused from Physical Education, athletics, or additional school activities for MORE than a week, a doctor’s note is required. This note should include the start date of the restriction as well as a release date.
  • If there are other restrictions for the student during the school day related to the injury, these should be noted as well.

Medication Administration

When a student requires medication, the primary responsibility for administering the medication rests with the parent. St. Patrick School recognizes that some short and long term medical conditions require medication prescribed at intervals that may include school hours. The administration of medication to students is subject to guidelines established by the Illinois School Board of Education.

No personnel shall administer to any student, nor shall any student possess or consume any prescription or non-prescription medication unless the completed Medication Authorization Form is on file in the Health Office. This form must be signed by the parent and completed by a physician prior to dispensing of any medications to the student. The nurse or school administration retains the discretion to deny requests for administration. To assist in safe monitoring of side effects and/or intended effects; faculty and staff may be informed of the medication plan.

When your physician has determined that medication is necessary during school hours, the following procedure must be followed.