Health Information


Valarie Green - Avoca West School (847) 724-6800

Health Documents

Health Forms

Required Health Information and Forms

*Access forms at the bottom of this page under health forms.  Print and complete each form.  Submit completed forms to the school nurse.

A Student Emergency/Medical Information form must be completed online by the first day of school.  This is part of the online registration process completed in the PowerSchool Parent Portal.

A State of Illinois Certificate of Child Health Examination form (Physical Exam Form) must be completed by a physician and parent for students entering KINDERGARTEN and SIXTH GRADE and STUDENTS transferring from out of state or out of the country.

An Illinois Department of Public Health Proof of Dental Examination (Dental Form) form must be completed for students entering KINDERGARTEN, SECOND and SIXTH GRADES.

A State of Illinois Eye Examination Report (Eye Exam Form) must be completed for any student entering the Illinois school system for the first time (out-of-state transfer or home schooled).

An Medication Authorization Form* must be completed by a physician and a parent for prescription and over-the-counter medication to be administered at school and on overnight school trips.  Students are not permitted to carry medication on school premises. The exception to this rule is students may carry and administer an inhaler or an Epi-Pen with physician and parent written authorization on the medication form.
*Can also be used for medications administration throughout the school year

A Food Allergy Action Plan (Food Allergy Form) form must be completed by a physician and parent for any student with a severe allergy which requires the administration of an Epi- Pen.

Proof of TDAP Vaccine. All students entering advancing or transferring into 6th, 7th, or 8th grade will be required to show proof of receipt of one dose of Tdap vaccine (combined tetanus, diphtheria, acellular pertussis) regardless of the interval since the last DTaP, DT or Td dose.

Proof of MMR, Varicella, and Meningitis Vaccine All students entering 6th grade will be required to show proof of receipt for two doses of MMR, two doses of Varicella, and one dose of Meningitis

Marie Murphy School Athletic Permit w/ Concussion Fact Sheet-UPDATED 
(Marie Murphy Athletic Permit Form) signed by a parent must be on file in the office of the school nurse (in addition to the Certificate of Child Health Examination that must be completed by a physician) before a student will be permitted to try out for interscholastic sports.  Student accident insurance is provided by the district at no cost to the student’s family.  Information regarding accident insurance is included in a summer mailing.

Vision and Hearing Screening

Annual vision screening is done on all preschool, K, 2nd, and 8th grade students.  Annual hearing screening is done on all preschool, K, 1st, and 3rd grade students. If you do not want to have your child participate in these programs, please notify the school nurse. Vision screening is not a substitute for a complete eye and vision examination by an eye doctor.  Your child is not required to undergo the vision screening if an optometrist or ophthalmologist has completed and signed a report indicating that an eye examination has been administered within the previous 12 months.

Medical Excuses

If a student needs to be excused from physical education or recess, a written excuse written by a parent/guardian is required.  The note from a parent/guardian will be valid for 3 consecutive physical education classes or recesses.   An injury requiring a student to be excused for more than 3 days will require a physician’s excuse.  The excuse must state the specific injury/problem, the dates the student cannot participate, and a date when the child can resume activity.

Students will not be allowed to resume activities until the physician’s release is received.

Student Concussions and Head Injuries  

Avoca School District 37 follows a state mandated policy regarding Student Athlete Concussions and Head Injuries and has appointed a Concussion Oversight Team, which ensures the District is maintaining a process for students suffering from a concussion or head injury to Return-to-Play and Return-to-Learn in accordance with the Youth Sports Concussion Safety Act and guidelines from the Center for Disease Control and Prevention.  If your student has been diagnosed with a concussion, or you suspect that you may know they have a concussion, please contact the school nurse in order to discuss a Return-to-Learn plan. All students and their parents are required to read and sign a Concussion Fact Sheet prior to registering for athletic extra-curricular activities. For more information regarding concussion and head injury policy and procedure, please refer to Avoca School District 37 Policy 7:305 and the Marie Murphy Athletic Permit with Concussion Fact Sheet.