School Wellness

Below are various health forms that are used throughout the school year.  Please print and fill out the form that you need and turn it into the school office.  Forms can also be faxed to 309-446-9500 or scanned and emailed to lonna.sumner@brimfield309.com. All forms need to be updated each school year.

Downloadable Health Forms

If you have any questions regarding health forms that may be needed for your child, please contact Lonna Sumner, RN at 309-446-3366 x 1119 or lonna.sumner@brimfield309.com 

When Not to Send Your Child to School

New Religious Exemption Requirements

NEW RELIGIOUS EXEMPTION RULES, EFFECTIVE OCTOBER 2015

    The state of Illinois requires all parents or guardians to provide evidence of completing the required physical examination and immunizations for school entry. In the event that a student has a religious exemption to either the physical examination, and/or immunizations, a religious exemption form must be filled out.  This is a new state law effective October 16, 2015.  The following form is the only form allowed and MUST be filled out and signed by a physician to qualify for the exemption.  A separate form will need to be filled out for each student.  

 This form may not be used for exemptions from immunizations and/or physical examination for personal or philosophical reasons.  Illinois state law does not allow for such exemptions.  

 

If you have any questions, please call Lonna Sumner, RN at 446-3366 x 1119.


New Immunization Requirements for 6th and 12th Grade

NEW IMMUNIZATION REQUIREMENTS FOR 6TH AND 12TH GRADE

All students entering 6th grade are required to receive one dose of MCV4 (meningococcal conjugate) vaccine prior to school entry; (Meningitis B vaccine will not be accepted)

All students entering 12th grade are required to show proof of two doses of MCV4 (meningococcal conjugate).  The 2nd dose must be administered on or after the student's 16th birthday or one dose is required if the 1st dose is received on or after age 16.

(Meningitis B vaccine will not be accepted)

 

*Failure to get these immunizations could result in your child being withheld from school. If you have any questions, please call Lonna Sumner, RN at 446-3366 x 1119.


School Exam/Immunization Requirements

SUMMARY OF SCHOOL EXAM AND IMMUNIZATION REQUIREMENTS

Failure to complete some of the following could result in your child being withheld from school.  

Please call Lonna Sumner, RN with any questions.  (446-3366 x 1119)

 

Pre-K

  • Physical Exam
  • Lead Test/Screening
  • TB Screening
  • Immunizations                    

     4 or more doses DTaP (booster after 4th birthday)

     3 or more doses Polio (booster after 4th birthday)

     2 doses MMR (first one must be after first birthday)

     1 dose Varicella (Chicken Pox)

     1 or more Hib doses

     3 Hepatitis B doses

     1 or more doses of Pneumococcal 

 Kindergarten:

  • Physical exam
  • Dental Exam
  • Eye Exam
  • Lead Test/Screening
  • Immunizations                    

     4 or more doses DTaP (booster after 4th birthday)

     3 or more doses Polio (booster after 4th birthday)

     2 doses MMR (first one must be after first birthday)

     2 doses Varicella (Chicken Pox)

 

2nd Grade

  • Dental Exam

 

6th Grade

  • Dental Exam
  • Physical Exam
  • Immunization

    1 dose of MCV4 (​Meningococcal Conjugate) (Meningitis B will not be accepted)

    1 dose of Tdap

 

 9th Grade

  • Physical Exam 
  • Dental Exam

 

12th Grade

  • Immunizations

     2 doses of MCV4 (meningococcal Conjugate) (Meningitis B will not be accepted)
    * 1 dose is required if first dose is given after 16th birthday.