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IDPH Forms

Certificate of Child

Health Examination

Dental Exam Proof

Eye Exam Proof    

District Forms

District Insurance

Medication Form    

Health History Form

All updated IHSA forms, including pre-participation examination forms can be found at:


Pre-participation Physical

If you have any questions, please contact your school nurse through the school office:

Alina Carner

- Nurse, Bluffview

618-286-3311 ext 3219

[email protected]

Kendra Koonce

- Nurse, JH/HS

618-286-3214 ext 4135

[email protected]

Danielle Harget

- Nurse, JH/HS

618-286-3214 ext 4135

[email protected]

Health Requirements for Dupo Fall 2022-23 Registration

Parent's Guide to Childhood Immunizations

Growing Up With Vaccines: What Should Parents Know

Meningococcal Vaccines for Preteens and Teens

Immunization Report 2017-18

Immunization Report 2018-19

Immunization Report 2019-20

Immunization Report 2020-21

The Flu: A Guide for Parents

Flu Vaccine for Preteens and Teens

Dental Safari Company, a mobile dental corporation, travels to schools to provide dental wellness checkups, and urgent care treatment, for children of all ages (pre-K through 12th grade).

Next visit:

September 7th and 8th, 2022

Steps to Sign-up for Dental Safari

  1. Complete the Online Dental Safari Consent Form
  2. Send a courtesy email to your school nurse letting them know you signed-up or forward your confirmation email from Dental Safari. Thank you!

Paper Dental Safari Consent Form

What's Your Cost? Form

Online Dental Safari Consent Form

Eligible Children:

Children with a Medicaid / All Kids Identification number

Children who are on free or reduced lunch program

Children with private insurance (provide information)

Child with cash payment (cash or check)

($68 – includes exam, cleaning, fluoride, sealants as needed)

PLEASE NOTE: If your child is in Kindergarten, 2nd, 6th, or 9th grade, the State of Illinois does requires a dental exam to be on file. This appointment fulfills that obligation.

Following your child’s treatment, a letter will be sent home indicating the treatment your child received during our visit as well as follow-up treatment he/she may need.

To take part in this service, please complete and return the consent form to the school nurse.

If you have any questions, please contact the nurse's office.


-Alina Carner

Bluffview Nurse

618-286-3311 x 3219

-Kendra Koonce

JH & HS Nurse

618-286-3814 x 4135