Health Forms


If you're a District 401 parent and you're looking for one of the many school health forms your child might need at some point this year, you've come to the right place.

To locate a form, scroll down this page or look at the left-hand column under "Health Forms." You'll find links to downloadable PDF versions of all the health forms applicable to D401 students. If we're missing any forms that you need, please let us know, and we'll add them as soon as possible.


Letter to Parents About Student Health Requirements


Begin by reading this letter from District 401 Superintendent Dr. Nicolas Wade:

► Student Health Requirements Entrance Letter to Parents

Then proceed to the appropriate section(s) below depending on your child's grade and/or other relevant factors.


Required for All Students


Download and submit this medical information form. All students — new or returning — must fill out and submit this annually updated document:

Student Medical Information Form


If You Are New To District 401


Download and submit the following two forms. These documents are required of any student who is new to District 401 regardless of grade (except preschoolers, who do not need to submit an eye exam report):

► Illinois Certificate of Child Health Examination Form

► Illinois Eye Examination Report (not required for preschool)

If your child is new to the District and is entering kindergarten, 2nd grade or 6th grade, this document is also required:

► Illinois Proof of School Dental Examination Form


If Your Child Is Entering Preschool


Download and submit the following form. This document is required of any D401 student who is entering preschool:

► Illinois Certificate of Child Health Examination Form


If Your Child Is Entering Kindergarten


Download and submit the following forms. These documents are required of any D401 student who is entering kindergarten:

► Illinois Certificate of Child Health Examination Form

► Illinois Proof of School Dental Examination Form

► Illinois Eye Examination Report


If Your Child Is Entering 2nd Grade


Download and submit the following form. This document is required of any D401 student who is entering 2nd grade:

► Illinois Proof of School Dental Examination Form


If Your Child Is Entering 6th Grade


Download and submit the following forms. These documents are required of any D401 student who is entering 6th grade:

► Illinois Certificate of Child Health Examination Form

► Illinois Proof of School Dental Examination Form


If Your Child Is Entering 9th Grade


Download and submit the following form. This document is required of any D401 student entering 9th grade:

► Illinois Certificate of Child Health Examination Form


If Your Child Wants to Join an Elm Sports Team


Download and submit the following form. This document is required of any student who wants to play sports for Elm Middle School:

► Sports Pre-Participation Examination Form


If Your Child Wants to Join an EPHS Sports Team


Download and submit the following form. This document is required of any student who wants to play sports for Elmwood Park High School:

► Sports Pre-Participation Examination Form


If Your Child Needs to Take Medication in School


Download and submit the following form. This document is required of any D401 student who needs to take medication while in school:

► Medication in School Form


If Your Child Is Returning to School With Restrictions


Download and submit the following form if you are returning with restrictions after an excused health-related absence. This form is optional:

► Return to School Form


If Your Child Has Asthma


Download this asthma action plan from the American Lung Association:

► Asthma Action Plan


If Your Child Has a Food Allergy


Download this food allergy and anaphylaxis emergency care plan from Food Allergy Research & Education (FARE):

► Food Allergy Action Plan


If Your Child Has a Seizure Disorder


Download this seizure action plan from the Epilepsy Foundation:

► Seizure Action Plan


If Your Child Will Use Loyola's Mobile Medical Unit


Download this consent form prepared by the Loyola University Medical Center:

► Mobile Medical Unit Health Care/Immunization Consent Form