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2025-26 Student Health Questionnaire

Please complete this required form for each of your children attending SJCS for 2025-26 school year.  Required fields marked are with an asterisk *

Gender*
Answer required for "Gender"
Grade Entering for 2024-2025 year*
Answer required for "Grade Entering for 2024-2025 year"

Health Requirements and Medical Upload

Dental forms are not due to the state until May 15th, however dental forms are good for 18 months, so if you have a dental form from any visit occuring between Jan 15th 2025 onwards please upload it now. Please make sure to upload the forms to the their correctly desigated places. The health requirements for each grade are as follows:

HEALTH REQUIREMENTS BY GRADE

 

Preschool- Only if entering SJCS Preschool for the first time. 

Physical

Kindergarten 

Physical EyeDental

Second Grade

Dental

Fifth- Eighth Grade

Sports Physical if participating in a school sponsored athletic program. IHSA Form

Sixth Grade

PhysicalDental

New Students (enrolling in an Illinois school for the first time) 

Physical,EyeDental (only if entering K, 2, 6th)

 

Preschool Physical Form
Answer required for "Preschool Physical Form"
or drag it here.
Kindergarten Forms (Physical, Dental, Eye)
Answer required for "Kindergarten Forms (Physical, Dental, Eye)"
or drag it here.
2nd grade Dental
Answer required for "2nd grade Dental "
or drag it here.
5th-8th grade Sport's Physical
Answer required for "5th-8th grade Sport's Physical"
or drag it here.
6th grade Forms (Physical, Dental)
Answer required for "6th grade Forms (Physical, Dental)"
or drag it here.
New Students (Physical, Dental, Eye)
Answer required for "New Students (Physical, Dental, Eye)"
or drag it here.
Does your child have any type of hearing or vision impairment?*
Answer required for "Does your child have any type of hearing or vision impairment?"
If you checked "yes" above, please check all that apply
Answer required for "If you checked \"yes\" above, please check all that apply"

Life Threatning Medical Conditions

Students with life-threatening medical conditions, where the condition would "put the child in danger during the school day", should have a nursing action plan and medication authorization form and physician's order (all listed below) in place before the first day of the new school year. These plans are required to be updated yearly, and includes individuals who are "self-caring / self-administering". 

Does your child have any Life Threatening Allergic Conditions?*
Please select all that apply
Answer required for "Does your child have any Life Threatening Allergic Conditions?"
Has the child's physician prescribed an Epi-Pen or any other medicine for a severe, life threatening allergy?*
If yes, it is strongly advised that he/she keeps a supply in the nurse's office; it is required for interscholastic sports (5-8), with a physician's order specifying "self administer". See school medication policy for more info.
Answer required for "Has the child's physician prescribed an Epi-Pen or any other medicine for a severe, life threatening allergy?"
Has your child been diagnosed by a licensed physician with any of the following health conditions?*
Check all that apply
Answer required for "Has your child been diagnosed by a licensed physician with any of the following health conditions?"
Medical Action Plan (asthma, allergy...)
Answer required for "Medical Action Plan (asthma, allergy...)"
or drag it here.
Medication Authorization and Physician Order
Answer required for "Medication Authorization and Physician Order"
or drag it here.

Daily Medications and School Medication Policy

If your child has a medical condition that requires medication (prescription or over-the-counter) to be administered during the school day, a written physician's order is required. No medication may be carried in school by a student; again, this applies to prescription or over-the-counter medications. 

The only exceptions are for those students with asthma inhalers and EpiPens whose order specifies that they may "self administer" their medication. All medication must be delivered to the school nurse's office in the original container or pharmacy bottle by the parent/guardian with the physician's original order and written parental permission. 

 

Will your child require to take medication(s) during the school day?*
Answer required for "Will your child require to take medication(s) during the school day?"
Medication Authorization and Physician Order
Answer required for "Medication Authorization and Physician Order "
or drag it here.
Is your child allergic to any of the following medications?*
Answer required for "Is your child allergic to any of the following medications?"
Confirmation Email