HEYWORTH HEALTH OFFICE-FORMS
The most commonly requested forms are available here. Both HUSD4 forms and Illinois state forms are listed. If you need a health related form that is not listed, email me at [email protected] and let me know.
Illinois School Physical Form- required for students entering their first year of Kindergarten, 6th grade and 9th grade and anyone transferring from another state.
IHSA Sports Physical Form-required for any student wanting to participate in IHSA sports programs.
Heyworth Medication Authorization Form-required for any student that has to take medications (over-the-counter or prescription) while at school.
The Certificate of Religious Exemption to Required Immunizations and/or Examinations Form- must be completed by parents/guardians and signed by healthcare provider for religious object to immunizations or required health exams.
Illinois Dental Exam Form-required for students entering Kindergarten, 2nd and 6th grades or students new to Illinois schools.
-Dental Exam Waiver
Illinois Eye Exam Form-required for students entering Kindergarten or students new to Illinois schools.
-Eye Exam Waiver
Activity Restriction/Return to Activity Form- can be used as guideline or clarification for activity restrictions or return to activity when signed by healthcare provider.
Heyworth Elementary School Pre-arranged Absence Form-see Parent/Student Handbook for more information.
Heyworth Jr/Sr High School Pre-arranged Absence Form -see Parent/Student Handbook for more information.
Illinois School Physical Form- required for students entering their first year of Kindergarten, 6th grade and 9th grade and anyone transferring from another state.
IHSA Sports Physical Form-required for any student wanting to participate in IHSA sports programs.
Heyworth Medication Authorization Form-required for any student that has to take medications (over-the-counter or prescription) while at school.
The Certificate of Religious Exemption to Required Immunizations and/or Examinations Form- must be completed by parents/guardians and signed by healthcare provider for religious object to immunizations or required health exams.
Illinois Dental Exam Form-required for students entering Kindergarten, 2nd and 6th grades or students new to Illinois schools.
-Dental Exam Waiver
Illinois Eye Exam Form-required for students entering Kindergarten or students new to Illinois schools.
-Eye Exam Waiver
Activity Restriction/Return to Activity Form- can be used as guideline or clarification for activity restrictions or return to activity when signed by healthcare provider.
Heyworth Elementary School Pre-arranged Absence Form-see Parent/Student Handbook for more information.
Heyworth Jr/Sr High School Pre-arranged Absence Form -see Parent/Student Handbook for more information.