Important State of Illinois forms required to attend MCVSD#40




Dear Families, 

The purpose of this letter is to make you aware of State health requirements for admission to an Illinois school and some important Moline-Coal Valley District No. 40 policies. All required immunizations and/or physicals must be completed by October 15 of the school year or the student may be excluded from school until completed. 

Physicals and Immunizations

The Illinois School Code, Chapter 122-Section 27-8, requires that all students have a physical examination 

completed on the state-mandated Illinois form by a physician licensed to practice medicine in all its branches

at the following times:

  1. Students entering an Illinois school for the first time (dated within one year of entry).
  2. Students entering preschool, kindergarten, sixth, and ninth grades.
  3. Students in ungraded classrooms must have a physical at ages 5, 10, 15, & 20 (prior to the 

                             date of entering and within one year of that date).

The parent must complete and sign the parent/guardian portion.

All students must present documented evidence of adequate immunizations for school attendance as required by the Illinois Department of Public Health:

DTP—4 doses with the last dose on or after the 4th birthday

Tdap—Proof of receipt of one dose of Tdap for all students entering 6th-12th grades 

Polio—First entry into school (Kindergarten/1st grade):  4 doses with the last dose received after 4th birthday

        All other grades:  Minimum 3 doses with the last dose on or after the 4th birthday

MMR—2 doses (1st dose must be on or after 1st birthday)

Pneumococcal series for children enrolled in a pre-kindergarten program--  (Not required after 5th birthday)

Hepatitis B— 3 doses for the following:

                         Any child two years of age or older entering a school program (i.e. pre-kindergarten, early

                         childhood, pre-school)

                         Students in 6-12th grade must have completed the three dose series.

Varicella (Chickenpox) - 2 doses 

Meningococcal-6th Grade-One dose after age 11     12th grade—2 doses unless first dose after age 16

Lead Screening—required for students through six years of age

HIB Series (Haemophilus Influenza Type B)—required for pre-kindergarten age

Dental Examination—required for students in kindergarten, second, sixth, and ninth grades.

Eye Examination—required for students entering kindergarten and new students enrolling in an Illinois school for the first time

If you object to these requirements on religious grounds, your child will not be required to comply if you present to the school a Statement of Religious Objection signed by you as well as the completion of the required Moline-Coal Valley School District No. 40 paperwork. This must be completed by October 15 as well to avoid exclusion.

Medication in School

Medication administration is normally not a function of education; however, Moline School Board Policy allows for medication to be given at school when:

  1. The physician states that the medication or treatment must be administered during the school day to allow the 

   student to attend school.

  1. The district’s medication forms are completed and signed by the physician and/or parent and are on file in the

     school office or clinic.

Medication should be brought to the school office or clinic and picked up by the parent or another responsible

person. Students are not allowed to carry medication on the bus. Students using inhalers for asthma control, Epi-pens for bee sting allergies, diabetic glucose monitoring or other “as needed” medications or treatments, must have the physician’s written authorization to“self-administer” their medication or carry it on their person at school. Your cooperation is greatly appreciated by the school staff as we work to make the Moline-Coal Valley Public Schools a safe and comfortable learning environment for your children. 


 (Rev 11/19)