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Dear Sixth Grade Parents/Guardians,

District 202 Health Services welcomes you and your child as he/she begins middle school!

The Illinois School Code Sec 27-8 requires all incoming sixth graders to have a health/physical examination with the required immunizations completed prior to the first day of school. Incoming sixth graders must use the State of Illinois Certificate of Child Health Examination form, which also serves as their sports physical for their first year. The Illinois Elementary School Association (IESA) sports physical form CANNOT be accepted as the sixth grade physical.

• Immunizations must include:

  • Diphtheria/Pertussis/Tetanus (DPT/DTAP) – Three (3) or more doses, including a booster on or after the 4th birthday.

  • Tdap (Boostrix/Adacel) - One (1) dose of Tdap

  • Polio (OPV/IPV) – Three (3) or more doses including a booster on or after the 4th birthday.

  • Measles/Mumps/Rubella (MMR) – Two (2) doses.  The first dose at 12 months of age or older and the second dose no less than four weeks (28 days) after the 1st dose.

  • Hepatitis B – 3-dose series.

  • Varicella – Two (2) doses. The first does on or after 1st birthday or a statement from physician verifying disease.

  • Meningococcal Conjugate (MCV4) – One (1) dose received on or after the 11th birthday

Dates of ALL immunizations must be verified by a physician or healthcare provider. The Student Information (top of page 1) and Health History sections (top of page 2) must be fully completed and signed by the parent/legal guardian. Furthermore, the physician must complete the diabetes screening section.

Transfer students must present a health exam that was completed within one year prior to entry into an Illinois school. The transferring health/physical exam must also include the dates of all previous immunizations since birth. (Please take note of the above required Illinois School Code schedule of immunizations required).

Plainfield School District #202 REQUIRES dental exams for all incoming sixth grade students. Health Exam form/Dental Forms/Eye Exam Form may be obtained here.

Please complete and return all original forms to the school nurse. Athletic/Band Personnel will accept copies only of the health forms for participation in any extracurricular activities. 

All paperwork is due to the health office by August 1st. Students not in compliance by the first day of school will be excluded from school until the required documentation is submitted to the health office.