Health Services

Shannon Beetz, RN, BSN

beetzs@lasalleschools.net

815-223-0786 ext. 389

Chelsea White, RN, BSN

whitec@lasalleschools.net

815-223-0786 ext. 272

IMMUNIZATION VERIFICATION 2021-2022

Please complete the Immunization Verification form to provide your student's vaccination status. This will help the school be better prepared to contact trace in the presence of a positive Covid-19 case. Thank you.

COVID-19 RETURN TO SCHOOL QUESTIONNAIRE

COVID-19 Return to School Questionnaire - Please complete as requested by the school nurse. Thank you!

SHIELD TESTING

LaSalle Elementary School District No.122 has partnered with SHIELD ILLINOIS, a University of Illinois based program which will provide saliva-based testing of unvaccinated students and staff members for the COVID-19 infection. Please print and complete this form or request a form in the school office. Thank you.

Physical & Immunization Requirements

REMINDER: 1st Day Exclusion Policy

All physical & immunization records must be submitted PRIOR to the first day of school. Forms may be brought to Northwest Elementary, Lincoln Junior High, registration, or the drop box in the forger at Northwest Elementary (after hours).

Failure to comply with the physical & immunization requirements by 8 a.m. on the first day of school will result in your child being excluded from school until such requirements are met. Please see Parent/Student Handbook for further information regarding the Districts 1st Day Exclusion Policy.

School Physical Form

Dental Examination Form

Eye Examination Form

Preschool Students:

  • Completed Illinois School Physical Form - signed by a licensed healthcare provider & parent. Exam must have occurred within 1 year of the child's first day of school. Due prior to 1st day of school.

  • Proof of current immunizations and/or Religious Exception Form - Due prior to 1st day of school.

Kindergarten Students

  • Completed Illinois School Physical Form - signed by a licensed healthcare provider & parent. Exam must have occurred within 1 year of the child's first day of school. Due prior to 1st day of school.

  • Proof of current immunizations and/or Religious Exemption Form - Due prior to 1st day of school.

  • Completed Eye Examination Form - The eye exam must be completed by a licensed eye doctor, optometrist or ophthalmologist within 1 year of the child's entry in kindergarten.

  • Completed Dental Examination form - The dental exam must be completed by a licensed dentist within 18 months prior to May 15th of the current school year.

2nd Grade Students

  • Completed Dental Examination form or waiver - The dental exam must be completed by a licensed dentist within 18 months prior to May 15th of the current school year.

6th Grade Students

  • Completed Illinois School Physical Form - signed by a licensed healthcare provider and parent. Exam must have occurred within 1 year of the child's first day of school. Due prior to 1st day of school.

  • Proof of current immunizations and/or Religious Exemption - INCLUDING proof of Tdap & Meningococcal vaccine given after age 11.

  • Completed Dental Examination form or waiver - The dental exam must be completed by a licensed dentist within 18 months prior to May 15th of the current school year.