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Leotis D. Swopes, Ed.D, Superintendent

We would like to take this opportunity to welcome your child to THORNTON TOWNSHIP HIGH SCHOOLS DISTRICT 205. To assist with this transition, we are sending you medical forms which must be completed and handed to the school nurse during “Registration and Schedule Pick-Up” in August. This applies to all incoming freshmen & transfer students. Your child will not be allowed to receive a schedule and start school until all required forms are submitted to the school nurse. Please do not mail forms to the school.

1. PHYSICAL EXAMINATION

A physical examination, including diabetic screening and physical education participation, approval must be completed and signed by the physician within one year of starting 9th grade. Parents must complete and sign the medical history portion on the back page of the form.

2. IMMUNIZATIONS

Day, month, and year of doses are required, as well as a signature and stamp by a health care provider. Doses must include:

• (3 doses) Polio with the last dose after age 4

• (3 doses) DTP/DTaP/Td with the last dose after age 4, along with a Tdap

• (3 doses) Hepatitis B

• (2 doses) Measles, (2 doses) Mumps, (2 doses) Rubella, (2 doses) Varicella {1st given on or after the 1st birthday; 2nd given no less than 4 weeks (28 days) later}

• Students entering 12th grade must show proof of receiving the Meningococcal Conjugate Vaccine, per Illinois State Board of Education requirements

3. EMERGENCY NOTIFICATION FORM

Please furnish us with as much information as possible on where you can be reached during school hours. Please consider the availability of the emergency contacts you designate to be called in the event you cannot be reached.

4. REQUEST FOR ADMINISTRATION OF MEDICATION

Illinois Law requires written physician and written parental permission for all prescribed and over-the-counter medications, including TYLENOL, which are administered during the school day. A school Medication Administration form is included for your student’s physician to complete in order for any and all medication to be administered during school hours.

Listed below is the contact information for the Nurses’ Office at each school.

In the absence of the nurse, an administrator will be available to assist.

|THORNRIDGE HIGH SCHOOL |THORNTON HIGH SCHOOL |THORNWOOD HIGH SCHOOL |

|SCHOOL NURSES’ OFFICE |SCHOOL NURSES’ OFFICE |SCHOOL NURSES’ OFFICE |

|708-225-4478/4479 |708-225-4178/4179 |708-225-4778/4779/4090 |

|Fax: 708-271-1786 |Fax: 708-225-4060 |Fax: 708-225-4856 |

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Thornton Township High School District 205

465 East 170th Street ( South Holland, Illinois 60473-3481

708.225.4000 ( fax: 708.225.4004



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