Health and Action Plan Forms can be found by Clicking the Menu option above, and then Documents\District\Health Services



Immunizations Required:

Dtap - 4 or more Rubella - 2

Polio - 4 or more Hep B - 3

Measles - 2 Varicella - 2

Mumps - 2

  • Current Physical (including LEAD and DIABETES screening-on physical)
  • Vision Exam (by an optometrist)
  • Dental Exam Turn in by May 1, 2020
  • Parent Consent Form

1st Grade:

  • Parent Consent Form

2nd Grade:

  • Dental Exam Turn in by May 1, 2020
  • Parent Consent Form

3rd Grade:

  • Parent Consent Form

4th Grade:

  • Parent Consent Form

5th Grade:

  • Parent Consent Form

6th Grade:

Immunizations Required:

1 Meningococcal Vaccination on or after 11th birthday

1 Tdap

Proof of the following vaccinations:


Varicella 2

Dtap 4 or more

Polio 4 or more

Hepatitis B 3

  • Current physical (sports physical does not qualify)
  • Dental Exam Turned in by May 1, 2020
  • Parent Consent Form

7th Grade:

  • Parent Consent Form

8th Grade:

  • Parent Consent Form

9th Grade:

Proof of the following Vaccinations:

Dtap - 4 or more Varicella 2

Polio 4 or more Meningococcal 1

MMR 2 Tdap 1

Hepatitis B

  • Parent Consent Form

10th Grade:

  • Parent Consent Form

11th Grade:

  • Parent Consent Form

12th Grade:

Proof of 2 Meningococcal Vaccinations

Parent Consent forms are available online. These forms need to be filled out each year for medical concerns. Also, if you want your child to take Tylenol or Ibuprofen as needed, at school.

If you have any questions please contact me, Sherry Hafer at 284-7723 ext. 4003, or contact your school nurse.

Thanks for your cooperation

Sherry Hafer RN

District Nurse

Meet Your Nurse

Sherry HaferDistrict Nurse 815-453-4966 ext. 4003
Chris PierceDixon High School815-453-4966
Cindy HoyleReagan Middle School815-253-4966
Courtney ForristallMadison School 815-934-9662
Amanda Costello Jefferson School815-934-9661
Joyce FaivreWashington School815-934-9660