U.S Department of Education | Blue Ribbon School District

Forms

Adaptive P.E. Referral Form by school
 Buffalo Grove  Elk Grove
 John Hersey  Prospect
 Rolling Meadows  Wheeling          

Exams
 Certificate of Child Health Examination  Certificate of Child Health Exam (Espanol)
 Examinación de la salud  Dental Examination            
 Eye Exam Report  Examinación Dental                                                           

Health Plans
 Allergy Emergency Health Care Plan  Seizure Health Care Plan
 Diabetes Health Care Plan  Autism Sd Plan
 Asthma Action Plan  
 Application for All Kids, FamilyCare, and Moms & Babies Health Insurance  Solicitud para el seguro de salud All Kids, FamilyCare y Moms & Babies
                                                                                                                      

Medication
 Asthma Inhaler/Epipen Self Administration Request  Prescription Medication Request                     
   

General Information
 Map of Immunization Clinics                                                                     Athletic Permit  (BGHS, EGHS, JHHS, PHS, RMHS, WHS)
   


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District 214| 2121 S. Goebbert Rd. Arlington Heights, IL 60005| 847-718-7600
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