Speed School District 802
Date:
2nd Request__________
3rd Request __________
Dear Parent/Guardian of ____________________________________
Illinois State Law requires all school children to have up to date health and immunization records. According to our health records, your child needs the services that are checked below.
_____ Physical Examination: Illinois Law requires- Kindergarten/1st, 6th grade and 9th grade on an Illinois
Certified Child Health Examination form. The Health History Section must be completed and signed
by the Parent/Guardian or the form cannot be accepted and will be returned.
_____ DPT/DTaP/DT/td: Illinois Law requires five doses – Four doses before the age 4 and one dose after age
(DT booster every 10 years thereafter)
_____ Tdap: Illinois law requires one dose for students entering 6th and 9th grade.
_____ IPV: Illinois Law requires four doses- Three doses before age 4 and one dose after age 4.
_____ MMR (Measles, Mumps, and Rubella): Illinois Law requires two doses before age 5
_____ HEP B or HB (Hepatitis B): Illinois Law requires three doses. 1st dose _____ 2nd_____ 3rd_____
_____ Varicella: Illinois Law requires one dose on or after the first birthday or statement from
Physician/health care provider verifying disease history or laboratory evidence of varicella immunity.
_____ Dental Examination: Illinois State Law, effective July 1st 20005, requires Kindergarten, 2nd and 6th grade on an Illinois Department of Public Health, Proof of School Dental Examination Form by a Dentist prior
To May 15th of the school year.
_____ Vision: Illinois Law requires a Vision Examination for kindergarten
The complete Certificate of Child Health Examination with documented immunization records are
Due: __________________ If you have any questions, Please call 708-481-610__.
Thank You,
SPEED School Health Services
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Telephone: 708-481-6100
TDD: 708-481-6100
Fax: 708-481-5713
SPEED S.E.J.A. #802
1125 Division Street
Chicago Heights, Illinois 60411-2491
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