For Parents

The Illinois State School Code Health Law, Section 665, requires that a child have a complete physical examination, including mandated immunizations, upon entrance into kindergarten.

Kindergarten Requirements

Physical Examination: Must be on the State of Illinois Certificate of Child Health Examination (11/2015) form and dated no more than one year earlier than 1st day of attendance of current school year.  

• Health History completed and signed by parent/guardian.
• Completed Immunization record signed by physician and include the following Immunizations:
  1 - Polio: 4 or more doses intervals no less than 4 weeks apart and the last dose received on or after the 4th birthday. A 4th dose is not necessary if the 3rd dose was administered after the age of 4yrs or older and 6 months after the previous dose.
  2 - Diphtheria, Tetanus, Pertussis (DTP/DTaP): 4 or more doses with the last dose received on and after the 4th birthday
  3 - Measles, Mumps, Rubella (MMR): 2 doses MMR on or after the 1st Birthday and the second dose no less than 4 wks after the first dose, or provided lab evidence of immunity.
  4 - Varicella: 2 doses on or after the first birthday and second dose no less than 4 weeks after the first dose. 
Physicians must address Diabetes Screening and Lead Risk Questionnaire portion of physical.

Vision Exam: Must be completed on the State of Illinois Eye exam report.
 • Completed, signed and dated by an Ophthalmologist or Optometrist
• Due October 15th

Dental Exam: Must be on the Proof of School Dental Examination Form State of Illinois and Due May 15th. The exam must take place 18 months prior to May 15th.

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