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Health Concerns
Parent/guardian must notify the school's nurse of any health conditions such as diabetes, seizures, asthma, or allergies
Parent/guardian are responsible for completing and returning required health forms and/or action plans.
Parent/guardian are responsible for communicating any updated health information to the school's nurse.
If your child has Food Allergies, Asthma, Diabetes and/or a Seizure disorder, please complete and return the below action plan(s), as applicable. A parent/guardian signature and physician signature are required. Action plans may also be obtained from your physician's office.
asthma-action-plan-aafa.pdfAsthma Action Plan
Food allergy action plan.pdfFood Allergy Action Plan
Diabetes-Medical-Management-Plan-6-2015-Option-2 (1).pdfDiabetes Medical Management Plan (DMMP)
Seizure Action Plan.pdfSeizure Action Plan
Consent Forms
In order for the nursing staff to exchange information and obtain needed forms with the healthcare provider(s), the FERPA/HIPAA consent form and the Authorization to Exchange of Student Health Records will need to be completed and returned to the school nurse.
Exchange of Education material.pdfReligious Exemption Form
Religious Exemption Form
Must be signed by parent/guardian AND physician.
Religious Exemption Form.pdfchild-health-exam-form-revised-01-31-2024.pdfState of Illinois Child Health Exam Form
Must be completed and signed by physician prior to entry into Pre-K, K, 6th, and 9th grades. Parent/guardian must also sign.
IHSA Pre-participation and Physical Examination Form
Must be completed and signed by a parent/guardian and physician for participation in interscholastic sports.
PreParticipationPhysicalForm.pdfCONSENT_ENGLISH_2023.pdfMiles of Smiles, Ltd.
Miles of Smiles, Ltd.
Miles of Smiles provides free dental services to any student, Pre-K through 8th grade, with a completed consent form. Services include dental exam, cleaning, fluoride treatment and sealants. Exams are compliant with the State of Illinois mandate. If you would like your student to be included in this service please complete and sign the consent form and turn the form in to your school nurse. Forms may also be faxed to 309-345-0023 or emailed to healthservices@galesburg205.org .
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