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Physical and Dental Forms

In compliance with State-mandated physical examination/ immunization requirements all students entering Early Childhood, Kindergarten, sixth and ninth grades must have a physical examination by a doctor.

To ensure adequate protection and a positive start to the new school year for all of our students, the nursing staff asks that ALL required physical examinations/ immunizations be submitted to the District or your child's school as soon as possible. (Please make a photocopy of all submitted exam forms to keep for your own records.)  At the high school level, forms may be mailed to York High School Health Services, 355 W. St. Charles Road, Elmhurst, IL 60126/Attention: Pat Hatz.

The Certificate of Child Health Examination, Proof of Dental Examination and Proof of Vision Exam may be picked up at your child's school office, the District 205 Center, 162 S. York Street, or downloaded from the District 205 website (on the New Student Enrollment page, click ”forms” under “Student Registration.”) Questions may be directed to your child’s school office/health office.

Due to the high demand for medical appointments with local physicians, it is recommended that you schedule appointments as soon as possible.

Following are the immunization/medical examination guidelines required by school policy and State law:

1. All health examinations must be dated within one year before entering Madison Early Childhood Education Center, Kindergarten, sixth and ninth grades.

2. All health examinations must be dated within one year of entering school when a student transfers from another Illinois school district and is entering Kindergarten, sixth or ninth grade.

3. Health examinations are required whenever an out-of-state student first enrolls in a District 205 school, regardless of the student’s grade.

Failure to comply with the above requirements by October 15 can result in the student’s exclusion from school until the required completed health forms are presented to the District.

Vision Exam

In addition to the physical examination and immunization requirements, the Illinois State Board of Education requires proof of a vision exam for all Kindergarten students, as well as for any new student entering the District for the first time. Vision exams must be documented on the Illinois Department of Public Health vision form. Parent(s)/guardian(s) must present proof of their child/children having been examined by an ophthalmologist or an optometrist before October 15 of the current school year for students entering Kindergarten and new students to the school district.

Vision Exam Form

Dental Exam

Dental exams are also required for students entering Kindergarten, second and sixth grades. Dental exams must be documented on the Illinois Department of Public Health dental form. Parent(s)/guardian(s) must present proof of their child/children having been examined by a licensed dentist before May 15 of the current school year.

Dental Examination Form

Formulario Comprobante Del Examen Dental Escolar

Sports Physicals

All middle and high school students who plan to participate in sports are reminded that physical examinations must cover them throughout the entire sport season. Sports physicals are required every year since they are effective for twelve months only. These students should schedule appointments accordingly.

Health Examination Form

Certificado De Examen De Salud Del Niño(a)

Medication

All students who are required to take medication (over-the-counter or prescription) during school hours (including inhalers, Epi-Pens, and insulin) must have a completed Medication Authorization Form on file, which is signed by the doctor and Parent/Guardian. The Medication Authorization Form must be completed annually or whenever there is a change in medication and/or dosage.

Medication Authorization Form

Medication Authorization (Self-Administer) Form

 

Administración de Medicinas por Personal del Distrito en la Escuela

Administración por si mismos de Medicinas por Estudiantes en la Escuela

The Illinois State Board of Education requires the school district to notify parents of the medication policy within 15 days of enrollment.

 Medication Policy

Other Forms

2014-15 Financial Assistance

The application for fee waiver will not affect the process that is currently in place for students qualifying for free or reduced meals through the National School Lunch Program. You will still need to complete a separate application for free or reduced meals through the National School Lunch Program. The fee waiver application and instructions are available below.

Forms will be available July 1.

Applications for the 2014-15 school year will be accepted starting July 1, 2014 (applications received before this date will be returned).

Financial Assistance waiver Application (2014-15)

National School Lunch Program Application (2014-15)

Completed free/reduced lunch applications must be turned in to your child's school for initial authorization.


 

York deferred payment

Form should be completed and returned with the pre-pack form or on book sale dates.

Deferred payment (York only)

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Acrobat Reader [Go]

A New Student Information Form must be filled out for new students entering the district to begin the registration process.

Special Residency Affidavit - If the student resides in a property owned or leased by someone other than their parent or guardian, a notarized residency affidavit must be signed by the owner of the lease or property.

Release of Records (Early Childhood/Elementary/Middle School)
Student Record Exchange (York)

Home Language Survey (English)
Home Language Survey (Spanish)
Home Language Survey (Polish)

Contact Information:

Elmhurst CUSD 205
162 S. York
Elmhurst, Illinois 60126

Ph: (630) 834-4530
Fax: (630) 617-2345

York Student Enrichment Team (YSET) Application Form

Families of York High School students that are experiencing financial hardship may contact the newly-formed York Student Enrichment Team (YSET) by emailing accessyork@elmhurst205.org or by calling 630-617-2442. All financial requests will be confidentially verified by the York Student Services Team, which includes counselors, social workers, teachers, deans and the Elmhurst police liaison. To ensure both confidentiality and impartiality, verified applications will be "blinded" (i.e., all personal information such as student and family name removed) and forwarded to the YSET Review Board for processing.

Established by parents, administrators and faculty in the Elmhurst District 205 community, YSET was formed earlier this summer to assist financially challenged families with course fees, book fees, and extracurricular fees.