Health Forms

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

Start with the section titled Letter to Parents About Student Health Requirements. This letter provides a detailed list of all immunizations, health exams and health forms required of District 401 students from preschool through 12th grade.

To Locate a Form

To find any of the forms that apply to your child, scroll down or use these quick links:

As mandated by Board Policy 7:100, failure to submit required health forms, or to follow through on exemption rules outlined by the Illinois Department of Public Health, will result in the student's exclusion from school until the required forms are presented to the District.

Letter to Parents About Student Health Requirements

Begin by reading this letter from District 401's Superintendent of Schools. This letter provides a detailed list of all immunizations, health exams and health forms required of District 401 students from preschool through 12th grade:

► Student Health Requirements Entrance Letter (English, Spanish, Polish)

For your convenience, this letter is also available to download in single languages: 

► Letter in English Only
► Letter in Spanish Only
► Letter in Polish Only

Then proceed to the appropriate section(s) below depending on your child's grade or other factors. Scroll down or go back to quick links to find the forms that apply to your child.

Required of 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
► Illinois Proof of School Dental 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:

► Athletic 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:

► Athletic Pre-Participation Examination Form

If Your Child Must Take Medication in School

Download and submit the following form. This document is required of any D401 student who must take medication while in school. The form authorizes the school nurse or other member of the District staff to administer the medication:

► Medication in School Form

If Your Child Must Self Administer Medication in School

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

► Self Administration of Medication 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

NOTE: The Loyola Pediatric Mobile Medical Unit (medical bus) is primarily for those who have no or limited insurance, are homeless or have public aid and cannot find a doctor to take them or cannot get a timely appointment. Contact your child's school nurse to see if your child is eligible to use the Mobile Medical Unit.

If your child is eligible, download both of these consent forms:

► Loyola Mobile Medical Unit Consent Form | Health Care/Immunization
► Loyola Mobile Medical Unit Consent Form | Release of Health Information