General School Information and Forms

As a reminder, the following forms and documents are required before your child’s first day of attendance. Please plan your appointments accordingly to ensure that you submit the forms needed. Once your health providers have completed these forms, please send the completed forms to Roycemore School via one of the following methods: 

Scan and email the forms and documents to forms@roycemoreschool.org 

Fax the forms and documents to 847-866-6545, Attn. Health Forms 

Drop off the forms and documents at the front desk 

Mail the forms and documents to: 

Roycemore School 

Attn. Health Forms

1200 Davis Street 

Evanston, IL 60201 

These completed forms and documents must be delivered to Roycemore School no later than the first day of school. Thank you. 

***Per the State of Illinois requirements, the following health forms must be on file with Roycemore School.


Allergy, Asthma, and Medication Forms 

● If your child has an allergy that requires an EpiPen, an Emergency Allergy Action Plan is required to be on file with Roycemore School 

● If your child has been diagnosed with asthma, an Emergency Asthma Action Plan is required to be on file with Roycemore School 

● If your child requires medication to be administered during the school day, a physician’s note is required to be on file with Roycemore School

Required Forms by Age

Kindergarten through Eighth Grade 

● Copy of Birth Certificate, if not yet submitted 

● Certificate of Child Health Examination Form 

● Proof of Dental Examination Form 

● Eye Examination Report Ninth Grade through Twelfth Grade 

● Copy of Birth Certificate, if not yet submitted 

● Certificate of Child Health Examination Form 

● Proof of Dental Examination Form 

● Eye Examination Report 

● Preparticipation Sports Examination Form, if your child is participating in sports


Pre-Kindergarten and Junior Kindergarten 

● Copy of Birth Certificate, if not yet submitted 

● Certificate of Child Health Examination Form

Kindergarten 

● Copy of Birth Certificate, if not yet submitted 

● Certificate of Child Health Examination Form 

● Proof of Dental Examination Form 

● Eye Examination Report Second Grade 

● Copy of Birth Certificate, if not yet submitted 

● Proof of Dental Examination Form Sixth Grade 

● Copy of Birth Certificate, if not yet submitted 

● Certificate of Child Health Examination Form 

● Proof of Dental Examination Form


Ninth Grade 

● Copy of Birth Certificate, if not yet submitted 

● Certificate of Child Health Examination Form 

● Proof of Dental Examination Form 

● Preparticipation Sports Examination Form, if your child is participating in sports Twelfth Grade ● Complete Immunization Record signed and stamped by a doctor, showing two doses of the Meningococcal vaccine with the 1st dose being on or after the 11th birthday & second dose on or after the 16th birthday UNLESS the first dose was administered after the age 16 years then one dose is required. 

● Preparticipation Sports Examination Form, if your child is participating in sports

2022-2023 State of Illinois Health Form Requirements 

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