Explanation of Forms:

ATHLETICS:

Athletic & Activity Consent Waiver

Any 7th through 12th grade student that tries out for an athletic team must have a completed form on file in the nurse’s office before tryouts begin.

Concussion Information & Form

Any 7th through 12th grade student that tries out for an athletic team must have a completed form on file in the nurse’s office before tryouts begin.

Sports Physical Form

Any 7th through 12th grade student that tries out for an athletic team must have a current physical on file in the nurse’s office before tryouts begin. *Sports Physicals cannot serve as the required 9th grade health physical. 

Drug Test Consent Form

Must be signed by HS athlete and parent at registration.

Drug Test Withdrawal Form

 Completed when student no longer participates in high school athletics. 

MEDICAL:

Physical Form

Kindergarten, 6th grade students, 9th grade students, and students new to the district are required to have a complete physical examination including immunizations before the first day of school.

Medication Consent Form

If a student needs to take medicine during school hours, this form must be completed with the medication information and signed by the doctor.

Release of Liability for Medication Form

Releases the district and its employees of any liability of any injury as a result in self-administered medications for students with asthma and/or severe allergies and/or diabetes. 

Food Allergy & Anaphylaxis Emergency Care Plan

Any student with food allergies needs a care plan on file.  Complete and return this plan to the Nurse before the first day of school.

Asthma Action Plan

Any student with asthma needs a care plan on file.  Complete and return this plan to the Nurse before the first day of school.

Physician Statement for Food Substitution

Reasonable food accommodations must be made when the accommodation requested is due to a disability and supported by a physician’s statement. Reasonable food accommodations may be made for children without disabilities who may still have special dietary needs; a medical statement may be required.

Eye Examination Form

This form is required for all incoming kindergarten students and students who are new to the district and have never attended an Illinois school before.

Dental Form

All Illinois children in kindergarten, Grade 2, Grade 6, and Grade 9 are required to have an oral health examination. This is required for all public, private, and parochial schools. Examinations must be performed by a licensed dentist, and he/she must sign the Proof of School Dental Examination form. Each child is required to present proof of examination by a dentist prior to May 15 of the school year.

ENROLLMENT FORMS:

Student Information Sheet and Student Enrollment Form 

Every student enrolled in CUSD#4 must have a completed Enrollment Form and Student Information Sheet on file, signed by a parent/guardian.

Media Consent Form

All students are required to have this form on file in the office. This form grants students' name and/or picture to be published in the media, grants authorization for access to the district's computer system, and acknowledges that the student has received a copy of the school handbook.

Fee Waiver Application

Students from a family that is below a certain income level may be eligible to have their registration fees waived.

Free and Reduced Lunch Application

Students from a family that is below a certain income level may be eligible for free or reduced lunches.

HIGH SCHOOL:

Community Service Form (High School Only)

The office tracks all community service hours completed by students. This information is used to determine awards given and to complete graduation requirements.

Guest Dance Form

If a CHS student desires to bring a student from another school to a dance, they must have this form completed and signed by each parent of the students attending.