Saint Andrew School Immunization and Health Form Requirements

All health forms are to be submitted to the office before the first day of school.
​All new students are required to submit a physical and immunizations record. ​

Physicals

Children must receive physical examinations prior to entering Illinois schools for the first time, prior to entering kindergarten, prior to entering sixth grade, and prior to entering ninth grade.

Dental Exams

Dental Exams are required for incoming Kindergarten, 2nd grade and 6th grade students.  Click here for Illinois Dental Exam Form. 
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Click here for the Illinois Dental Waiver Form.  This form can be used if your child is  enrolled in the free and reduced lunch program and is not covered by private or public dental insurance (Medicaid/All Kids),  enrolled in the free and reduced lunch program and is ineligible for public insurance (Medicaid/All Kids),  enrolled in Medicaid/All Kids, but we are unable to find a dentist or dental clinic in our community that is able to see my child and will accept Medicaid/All Kids, or  does not have any type of dental insurance, and there are no low-cost dental clinics in our community that will see my child.

Download Form

Immunizations

Immunizations that are required by age 3 - 3 doses of HepB, 4 doses of DTaP, 3 doses in series of Hib, 3 doses of IPV, one dose of MMR, and one dose of Varicella
  
Immunizations required for Kindergarten are  a 5th dose of DTap, a 4th dose of IPV, a 2nd dose of MMR, and a 2nd dose of Varicella
 
Immunizations required for 6th grade are one dose of Meningococcal and one dose of Tdap. 
 
Click here for State of Illinois Certificate of Child Health Examination 

Download Form

Vision Exam

All children enrolling in kindergarten and any student enrolling for the first time are required to have an eye examination.  Click here for the Illinois Vision Exam Form.

Click here for the Illinois Vision Waiver Form.   This form may be used if your child is enrolled in medical assistance/ALL KIDS, but we are unable to find a medical doctor who performs eye examinations or an optometrist in the community who is able to examine my child and accepts medical assistance/ ALL KIDS, does not have any type of medical or vision/eye care coverage, my child does not qualify for medical assistance/ ALL KIDS orthere are no low-cost vision/eye clinics in our community that will see my child, and I have exhausted all other means and do not have sufficient income to provide my child with an eye examination.

Download Form