Medical Forms

Parents have the primary responsibility for the health of their children. The efforts of the school are directed to help parents recognize and assume this responsibility.

A trained staff provides quality care to the children in our six Wilmette schools. The District employs registered nurses or licensed practical nurses for the full-time health paraprofessional positions.

According to the School Code of Illinois, physical examinations are required of all students, completed within one year prior to the entrance of preschool, kindergarten and 6th grade, as well as students transferring from another state or from another country. This physical exam must be recorded by the State of Illinois (Certificate of Child Health Examination form). For students transferring from another Illinois school, transfer health records will be accepted as long as they are received by the deadline and found to be complete.

Physical and dental examination forms are available from the school health office or secretary, or may be downloaded below. All health examination forms must be dated.

Children are not permitted to enter school until this requirement is met. If you have questions about health services in District 39, please contact the health services provider at your school.

Health Services Forms
Form Description Download
Physical Exam This form is required for all students who are new to District 39, as well as all students entering Kindergarten and 6th Grade. Physical Exam
Vision Exam This form is required for all students who are new to District 39, as well as students entering Kindergarten. Vision Exam
Dental Exam This form is required for all students who are new to District 39, as well as students in Grades K, 2 and 6 by May 15 of that school year. Dental Exam
Medication Authorization Packet This packet is for any medication (prescription or over-the-counter) to be administered at school. Medication Authorization
Emergency Action Plan For children with severe allergies, an Allergy Emergency Action Plan and Treatment Authorization (e.g., Epi-Pens). Emergency Action Plan
Asthma Action Plan For children with asthma, an Asthma Action Plan to be kept on file. Asthma Action Plan
FAQ Frequently Asked Questions about Health Records Requirements Health Forms FAQ

All forms are in PDF format, and may be viewed with Preview (on a Mac) or with Adobe Reader (any platform).

Concussion Information

Communal Food in the Classroom


District 39 recognizes the importance of healthy nutrition and protection of students with life-threatening food allergies. We also recognize celebrating accomplishments and milestones and the variety of ways to appropriately celebrate. Since food may be a component to events, a review of food in the classroom was conducted to update guidelines for the elementary buildings. Please refer to District 39’s Resource Guide for Supporting Children with Life-Threatening Allergies (adopted 3/23/05; revised 4/2013) for comprehensive guidance related to allergies.

General Guidelines for Communal Food

  1. District 39 discourages the use of food as a reward.
  2. District 39 encourages alternate methods for recognition of birthdays other than food treats. Some possible non-edible alternatives are school supplies, pencils, stickers, note pads, donating a book in your child’s name for his/her classroom or school library, a parent or family member may read to his/her class in honor of the event, or the donation of a game or activity to his/her classroom.
  3. Activities across classrooms involving communal food sharing are not recommended, as this increases the likelihood that a student could ingest a food containing an ingredient that may cause an allergic reaction. Any such activity will need the Principal's permission and a formal plan to communicate food allergies to parents providing the food and parents of children with allergies.
  4. If food is brought into the classroom to be shared, items should be commercially prepared or prepared by licensed food vendors. This includes fruits and vegetables. Pre-packaging will avoid the possibility of cross-contamination. Pre-packaged foods should list all ingredients on the labels.
  5. For any food or drink brought into school for instructional purposes or celebrations, the classroom teacher should authorize and approve the food selection at least two days in advance.
  6. Curriculum and supporting activities will be reviewed individually as needed to evaluate the use of food for projects.

Food From the School Garden

As D39 Outdoor Classrooms have grown and developed, most have been able to engage students in learning about the growing process and nutrition through the planting of vegetables and fruits. Students have opportunities to plant from seed and care for a variety of vegetables and fruits while discussing topics such as weather, climate change, life cycles, environmental awareness and ecosystems. When students are involved in harvesting, we may discuss local food sources, nutrition and cooking with vegetables. 

In order to support D39 nutrition goals and increase student contact with edible gardens, the Outdoor Classrooms can provide a direct source of “farm to table” vegetables. Students experience hands-on opportunities to grow a variety of vegetables or fruit in each of our school gardens. If the following practices and guidelines are followed, the produce can be served as part of school lunches or used in classrooms. 

  1. Outdoor Classrooms in District 39 have been cost-neutral initiatives, and are financially supported by funds from the Foundation and from each building PTA/PTO, as well as organizations such as “Go Green Wilmette.” Funding for the gardens will continue to be the responsibility of these organizations.

  2. D39 schools interested in building an edible garden will conduct soil sample testing in the area in which vegetables are to be grown. Soil samples must be sent to one of the two approved soil-­testing laboratories: A&A Great Lakes Agricultural Lab in Ft. Wayne, Ind., or GMS Laboratories in Cropsey, Ill. Initial soil tests must be conducted for pH level, organic content and nutrient levels, as well as heavy metals. At a minimum, they must test for lead, arsenic, cadmium and chromium. Soil testing for pH level, organic content and nutrient analysis must be repeated every 3‐4 years. Testing results must be submitted to the Food Service Coordinator.

  3. All added soil must be organic and purchased from a commercial outlet. Product information on the packaging must not include composted manure.

  4. Vegetables will only be planted in raised beds or ground level gardens in which soil testing for food consumption has occurred.

  5. Materials used for garden beds, containers, stakes or trellises must be constructed of non-toxic, non-­leaching material. Pressure-treated lumber and used tires are prohibited. If recycled materials are used to construct fencing, stakes, trellises, or other support structures, they cannot contain lead paint.

  6.  Compost generated on site may be used in the edible garden as long as it complies with organic definitions and practices and does not include food scraps in open compost bins.

  7.  Plant materials, including weeds, may be added to compost piles throughout and at the end of the growing season so long as they are free from disease, insects, pests, and weeds.

  8.  Use of raw or composted manure is prohibited.

  9.  Maintenance and sanitation practices to control diseases, weeds, and habitat for pests will include only organic methods of production as defined by the USDA National Organic Program and in accordance with the State of Illinois Department of Public Health.

  10.  Schools installing and maintaining an edible garden will develop a monitoring and record keeping system in accordance with the school’s Integrated Pest Management (IPM) plan.

  11.  Water used in the garden must come from a tested source. Standing water may not be used on edible gardens (no rain barrels).

  12.  Seeds or seedlings must be non-­‐genetically modified and come from companies that have taken the “safe seed pledge” as per the Council for Responsible Genetics. Their website has the safe seeds resource lists, including those listed in Illinois below: 

        Borries Open Pollinated Seed Corn Farm
293 E. 1400th Ave
Teutopolis, IL 62467
Tel: 217-857-­3377

        Safeguard Seeds
P.O. Box 1036
Mokena, IL 60448
Tel: 855-730-­7333

        Underwood Gardens
        1414 Zimmerman Road
      Woodstock, IL 60098
      Email: [email protected] 

13. Prior to working or harvesting in the garden, all participants will wash his or her hands in warm soapy water for 20 seconds (rinsing of the soapy water must be from a running water source such as a hose or faucet). Sanitation codes require this of anyone working with food preparation.

14. To sample produce directly from the garden, hands and produce must be properly sanitized and washed (in the garden with running water from the hose or in the school kitchen) just prior to ingesting.

15. For food consumed in the cafeteria or classrooms, food service staff will clean and store produce properly until ready for use in the cafeteria or classrooms. They will follow existing guidelines for food safety.

16. Utensils used for cutting or preparing garden produce must be the property of the school district. Each cafeteria will be stocked with a cutting board and knife for the purpose of classroom edible garden use.

17. Garden produce will not be ingested unless it complies with the above practices and with the permission of school personnel. 

"Best Practices for Food Safety in the School Garden." Food Safety in the Garden. Adapted from CFSC and National Farm-­‐to-­‐School Network Food Safety and School Garden Best Practices, 21 June 2011. Web. 21 May 2012. <­‐garden-­‐-­‐food-­‐cafeteria-­‐lunch>.

Busard, Peg, Horticultural Specialist, Plant Information Service, Chicago Botanic Garden ( [email protected])

College of Agriculture & Natural Resources, Jan. 2010. Web. 12 May 2012. < >. Home Page -­‐-­‐ "Fresh, Healthy and Safe Food: Best Practices Using Produce from School Gardens." Home Page -­‐ Home Page -­‐-­‐ Web. 21 May 2012. <>.

"Food Safety in the School Garden-­‐Grow It, Eat It." Maryland's Food Gardening Network.

Good Food Festival & Conference, March 15-­‐17, 2012. Seminars in “School Food Safety” and “Local Food Procurement.

Illinois Department of Health

USDA. “Food Safety Tips for School Gardens.” USDA, 2009. Web.­‐Memose/2009/SP_32-­‐ 2009_os.pdf

USDA National Organic Program 

Allergy Resource Guide

The purpose of this manual is to provide a guideline for supporting children with life-threatening allergies in school. This resource is to assist teams in developing individual plans for children.

District 39 Resource Guide for Supporting Children with Life-Threatening Allergies

The CDC released these guidelines for managing food allergies in schools:

Voluntary Guidelines for Managing Food Allergies in Schools 

Good health habits at home can help stop germs

  1. Stay Healthy
    • Avoid close contact with people who are sick.  When you are sick, keep your distance from others to protect others from getting sick.
    • Wash your hands thoroughly with soap and water.  Hands should be washed for a minimum of 20 seconds, rubbing vigorously.
    • Avoid touching your eyes, nose, or mouth.  After you use a tissue, wash your hands thoroughly.
    • Practice other good health habits ~ get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat healthy foods.
    • Get a flu shot, IF recommended for your age and health conditions AND if your physician recommends it.
  2. Stop the Spread of Germs
    • Cover your nose and mouth with a tissue every time you cough or sneeze.  Be sure to throw your used tissue in the garbage.
    • If you don’t have a tissue, sneeze or cough into your sleeve--- NOT into your hands.
    • After coughing, sneezing, or blowing your nose, ALWAYS wash your hands thoroughly with soap and water.  Hand washing is the #1 way to prevent the transmission of germs.
    • Stay home when you are sick.  Parents should keep children home from school whenever there is a fever and/or a cough.
    • Do not share eating utensils, drinking glasses, towels or other personal items.
    • Frequently touched surfaces like doorknobs, phones, faucet handles, and light switches should be sanitized regularly

Informational Materials Regarding Influenza and Meningococcal Disease