Christian Liberty Academy

Health Information

School Nurse: Mrs. Nancy Kramer, R.N., B.S.N.
Email:  This email address is being protected from spambots. You need JavaScript enabled to view it. 

Nurse's Office Hours: 8:30am to 3:30pm

Nurse's Blog:  Healthtalk

Welcome to Christian Liberty Academy! The goal of the Christian Liberty Academy Nurse's Office is to promote the optimum health of all students so that they may receive maximum benefit from their educational experience.  In order to make sure your child stays safe and healthy while in school, we require the following information to be submitted. In addition, if your child has a chronic health condition, such as asthma, diabetes, seizures, etc., please notify your school nurse immediately, as additional information will be required as described below.

Nurse's Office

Please notify the clinic of any medical changes in your student (i.e. surgery, major injuries, changes in medication, etc.) and maintain up-to-date address and phone number information with the registrar (847) 385 - 2011. If your student has surgery, please notify me. You will need to provide me with a doctor's release to return to school. Any doctor's note with medical information needs to be turned in to the clinic.

Required Medical Forms

Please click here to see all medicals forms.


Health Emergency Form

 Every student must have a yearly updated Health Emergency Form.  Please submit this by August 1st or immediately upon registration if you come in and register in the summer months. Please use the form printed on heavier weight paper that was sent home at the end of the school year or that you were given upon registration.  

Medical Enrollment Requirements


FORM PS JK SK1 SK2 1 2 3 4 5 6 7 8 9 10 11 12
Health Emergency Form

















**Certificate of Child












Dental Examination









Vision Examination




Sports Physical                 X X X X X X X X


**A sports physical will NOT be accepted for the Certificate of Child Health Examination, as it is not a complete exam.



Health Emergency Form

All Students

All Students

**Certificate of Child Health Examination

All Students

Copy of most recent required physical depending on grade level

Dental Examination

Grades SK, 2, & 6

Grades SK, 2, & 6

Vision Examination

All Students

Grade SK

Sports Physical Grades 5-12 done yearly for all athletes participating in a team sport Grades 5-12 done yearly for all athletes participating in a team sport

**A sports physical will NOT be accepted for the Certificate of Child Health Examination, as it is not a complete exam.


The State of Illinois Certificate of Child Health Examination must be completed by your health care provider with the month, day, and year of every dose of vaccine administered.  The following are the current required vaccine doses by grade:


FORM PS JK SK 1 2 3 4 5 6 7 8 9 10 11 12


3 3 4 4 4 4 4 4 4 4 4 4 4 4 4


                1 1 1 1 1 1 1


3 3 3 3 3 3 3 3 3 3 3 3 3 3 3


series series                          


3 3             3 3 3 3 3 3 3



1 1 2 2 2 1 1 1 2 2 2 2 2 2 1


1 1 2 2 2 2 2 2 2 2 2 2 2 2 2



series series                          



                1 1 0 0 0 0 2


PLEASE NOTE:  We do not force anyone to have immunizations that they object to.  We believe that the health of the child is the responsibility of the parent.  You may write and submit a religious exemption letter – see the detailed information below under "Physical Form and Immunizations" section.  We must have some kind of paperwork on file for accreditation purposes:  the record of vaccinations, a medical exemption letter from a physician, or the State of Illinois Certificate of Religious Exemption to Required Immunizations.

New Immunization Requirements


Applies to students entering grades 6 & 12 grades beginning with the 2015-2016 school year. All students entering grade 6 must show proof of receiving one dose of meningococcal conjugate vaccine (MCV4) on or after 11 years of age on their 6th grade physical exam form. **All students entering grade 12 must show proof of receiving two doses of meningococcal conjugate vaccine. If the first dose of MCV4 was administered after 16 years of age, then only 1 dose of MCV4 is required at grade 12 entrance.


Progression of 2 Dose Varicella Vaccine Requirement for Completion by All grades (K-12) by 2019 (Underlined Grade Level Indicates 2 doses required)
2016-2017 K 1 2 3 4 5 6 7 8 9 10 11 12
2017-2018 K 1 2 3 4 5 6 7 8 9 10 11 12
2018-2019 K 1 2 3 4 5 6 7 8 9 10 11 12
2019-2020 K 1 2 3 4 5 6 7 8 9 10 11 12 


Illinois Department of Public Health rules adopted in September 2011 now mandate that all students currently enrolled in grades six through twelve, shall show proof of receiving one dose of Tdap (defined as tetanus, diphtheria, acellular pertussis) vaccine regardless of the interval since the last Dtap, DT or Td dose.

Physical Forms and Immunizations

Grades Preschool, K, 6 and 9

Child Health Examination forms and required immunizations must be submitted prior to the first day of school for students in grades Preschool, JK, SK, 6 and 9.

  1. The physical exam must be completed within one calendar year prior to the start of school and must fulfill all Illinois State Board of Education and Illinois Department of Public Health requirements.

  2. If you cannot see your doctor, there are a number of places that offer these services including immediate care centers and drug stores with clinics. See the table provided on the next page.

  3. Students who are new to CLA and IL schools must submit health records upon entry into school. Transferred health records will be reviewed by the school nurse for compliance with Illinois school health requirements.

  4. **Students who have not received immunizations due to religious beliefs should present a written note explaining their personal religious objections.

  5. **Students who have not received immunizations due to medical objections should present a note from the physician stating the medical condition that contraindicates the immunization. 

**According to state law 105 ILCS 5/27-8.1(8) Parents or legal guardians who object to health, dental, or eye examinations or any part thereof, or to immunizations, on religious grounds shall not be required to submit their children or wards to the examinations or immunizations to which they so object if such parents or legal guardians present to the appropriate local school authority a signed statement of objection, detailing the grounds for the objection. If the physical condition of the child is such that any one or more of the immunizing agents should not be administered, the examining physician, advanced practice nurse, or physician assistant responsible for the performance of the health examination shall endorse that fact upon the health examination form. Exempting a child from the health, dental, or eye examination does not exempt the child from participation in the program of physical education training provided in Sections 27-5 through 27-7 of this Code [105 ILCS 5/27-5 through 105 ILCS 5/27-7]. 

  How to complete the Certificate of Religious Exemption to Required Immunizations and/or
Examinations Form
  • Complete the Parent/Guardian sections, which include key information about the student and the school the student will be entering, and the immunizations or examinations for which religious exemption is being requested. Provide a statement of religious belief(s) for each vaccination/examination requested.
  • The form must be signed by the child’s parent or legal guardian AND the child’s health care provider* responsible for performing the child’s health examination
  • Submit the completed form to local school authority prior to the first day of the school year.

Dental Forms

Illinois State law mandates that all SK, 2 and 6 grade students present proof of a dental examination prior to May 15 of that school year and must be completed within 18 months prior to the required date. A waiver has been established by the Illinois Department of Public Health for students who show undue burden or lack of access to a dentist.

Kindergarten Vision Examination Forms

Illinois State law mandates that all incoming grade SK, homeschool transfers, and out of state transfers must present a vision exam report conducted by a physician who provides a complete eye exam or a licensed optometrist. This report must be submitted to the school by October 15 of the school year and must be completed within one year prior to the required date. A waiver has been established by the Illinois Department of Public Health for students who show undue burden or lack of access to an ophthalmologist or optometrist.

Sports Exam:

IHSA member schools are required to keep a signed Concussion Acknowledgement and Consent form and a current Pre-participation Physical Examination on file for all student athletes participating on sports teams.  Religious exemptions are not accepted in place of the exam, only the vaccinations.  For students in 6th and 9th grades, the State of Illinois Certificate of Child Health Examination Form (CCHE) will serve as the physical exam section of the sports physical.  Sport physicals deadline dates for 5th through 12th grade athletes are the first day of practice for the sport the student is participating in. There cannot be any exceptions.

The following forms may be applicable to your child:

Please Note: If you are going to the doctor and your child has any of the conditions or medication needs listed below, please read this section and download the forms from our website that the doctor must complete or obtain them from the School Nurse before your appointment.

  1. Special Health Care Plans: If your child has one of the conditions listed below that requires nursing care at school, please obtain the appropriate form and take it to your doctor for completion. These conditions require a special health care plan: ADD/ADHD, food allergy, asthma, diabetes, seizure disorder, acute concussion care plan. Also, an Individual Health Care Plan is available for all other conditions that may require the nurse to assist your child at school.

  2. Medications: Illinois state law mandates that a permission form needs to be signed for ALL medication given, prescription or non-prescription signed by the doctor and the parent/guardians. Should your child need to take medication at school and the nurse must administer or oversee the administration of that medication, please submit a Prescription Medication/Procedure Doctor’s Order.  If over-the-counter medications are needed, please submit the Non-Prescription Medication Doctor’s Authorization Form.

  3. Should your child need to carry an asthma inhaler or EpiPen, there is a section on the Prescription Medication/Procedure Doctor’s Order form that needs to be completed for the student to carry medications at school.

Medication Drop-Off Procedure

You must see the nurse because a doctor's order is required for ALL medication given, prescription or non-prescription.

Please wait for the nurse to arrive or go and drop your child off at their classroom and come back - this would be a good time to tell the teacher what time you want your child to see the nurse for medicine. The nurse cannot leave the Nurse's Office to deliver medications and treatments. It is the student's responsibility to come to the Nurse's Office. "Reminder" stickers are available in the Nurse's Office.

Please do not leave medicine at the School Office. The nurse will have questions for you that the office secretaries will not know to ask AND you need to sign permission forms.

Please do not give medication to the teacher or ask the teacher to give medication to your child for any reason. This is for safety and liability reasons.

In order to prevent medication errors: medication given at school must be sent in the original container from the pharmacy that includes original pharmacy label with doctor's name and instructions. Non-prescription medication must be sent in the original container as well. If you want to only send in the amount of medication that the child will need at school, please send it in the original container and you keep the unmarked containers for yourself. Any medication sent in a baggie or poured into other containers will not be given for any reason. For the same reason, all labels and containers must be in English or the medication cannot be given.

FOR THE SAFETY OF OTHER CHILDREN, PLEASE DO NOT put medication in your child's lunchbox for them to take by themselves.

When Should Your Child Stay Home From School?

Good attendance at school is important in order for a child to do well. However, there will be times when your child is really too ill to attend. Either they are contagious to the other students or they feel so poorly that they would gain nothing from being at school. The following symptoms can help you determine whether your child should stay home.

Awaiting Results of a Strep Throat Culture

Rather than exposing your child's classmates to infection, wait until 24-hour culture results are in before returning your student to school. If it is negative, and your child is fever free, you can always bring your child in late.

Conjunctivitis (Pink Eye)

Following a diagnosis of conjunctivitis, the child may not return to school until after 24 hours AND the first dose of prescribed medication is administered.

Diarrhea and vomiting

If your child has repeated episodes of diarrhea and vomiting, accompanied by fever, a rash or general weakness, consult a doctor and keep your child out of school until the illness passes.

Head Lice

Students determined to have head lice infestation or the presence of adult lice or eggs (nits) are not permitted in school until there are no live lice detected or majority of the nits are gone. Please refer to Lice Information.


Children who have a temperature of 100 degrees or more do not belong in school. Any fever within the past 24 hours indicates the need to stay home. For example, at bedtime your youngster has a fever of 101 degrees but in the morning awakens with a temperature of 97.6. Keep your child home.

Fever is an important symptom; when it occurs along with a sore throat, an earache, nausea, listlessness, or a rash, your child may be carrying something very contagious. Most pediatricians advise parents to keep children home during the course of a fever and for an additional 24 hours after the fever has passed (without giving fever-reducing medicine such as Tylenol or Motrin).


Children with undiagnosed rashes are not allowed in school. A doctor should be consulted for a diagnosis. A doctor should see children with fever and rash.

Runny Nose / Cold Symptoms

A bad cough or cold symptoms can indicate a severe cold, bronchitis, flu or even pneumonia. Some children suffer one cold after another all winter long and a run-of-the- mill cold should not be a reason to miss school. However, if your child is not acting "right" or has difficulty breathing, it could be serious. Check with your pediatrician right away.

You Suspect Any Type of Illness/Infection

Should your child have symptoms of illness not mentioned here which may or may not be contagious, feel free to call the school nurse to run the symptoms by her when deciding whether to send your child to school, 847-385-2014.

PLEASE REMEMBER: A sick child cannot learn effectively and is unable to participate in classes in a meaningful way. Keeping a sick child home prevents the spread of illness in the school community and allows the child opportunity to rest and recover.

Area School Physical and Immunization Providers:

Please Note:  This list is provided for your convenience and information, however we do not make recommendations or assume responsibility for the quality of services provided.  IMPORTANT:  Immunizations will not be given at these establishments unless you bring your immunization records with you.  Please bring the appropriate physical exam form with you as they do not always have the correct form.

Updated April 2016 - Please call before going for updated information.



Appointment Needed

Dates / Times


Physical Exam

Village of Arlington Heights
33 S. Arlington Hts. Rd., Arlington Hts., IL

847-368-5760 Reservations required 1 week before

2nd Monday of the Month
5 – 7 pm

$10 per shot
Low Cost


Family Practice Center
371 NW Hwy.
Palatine, IL 60067

847-776-7800 Walk-in

M-F 9am – 9pm
Sat./Sun 10am – 8pm

N/A except flu shot

School $49
Sports $49

Physician Care
1925 E, Rand Road Arlington Heights, IL 60004

312-229-0350 Walk-in Mon-Sat 9am – 7pm Yes
Low cost
School $50

Emery Medical Center
2380 S. Elmhurst Rd.
Mt Prospect, IL 60056


Sat. by appt. only

M-T 8am – 7pm
Fri. 8am-6pm
Sat. 9am – 2pm

$10 each School $40

Children's Care Hoffman Estates
Hoffman Estates Village Hall
1900 Hassell Road

847-781-7850 No

1st Monday of the Month
3:30pm to 6:00pm
(also 3rd Mon. in August) (No clinic in July, Sept – changed to 2nd Monday)

$8 per shot
For residents;
$10 per shot for non-residents;
Free with AllKids


Walgreens Health Care Clinic
3 East Golf Rd., Arl. Hts. Or
375 E. Dundee, Palatine

Arlington Hts.:


M-F 8am -7:30pm
Sat./Sun 9am-4:30pm

Varies depending on insurance

School $60
Sports $60
Not covered by insurance.

CVS Minute Clinics:

2045 Plum Grove Rd, Rolling Mdws
1801 Golf Rd, Schaumburg 1855 W. Irving Pk. Rd. Schaumburg
101 S. NW Hwy, Barrington 1305 Randall Rd, Crystal Lake

Rolling Mdws: 847-303-2451 Schaumburg: Golf Rd.: 847-885-1326 Irving Pk. Rd: 630-893-5570 Barrington: 847-381-4105 Crystal Lake: 815-356-0386


M-F  8:30am – 7:30pm
Sat.  9am – 5pm
Sun. 9am – 4:30pm


Sports $59
General Medical Exam $79





Message from the Nurse

"Hello, my name is Nancy Kramer and I have been the School Nurse for Christian Liberty Academy since 1996. I have experience in Hospital, Community Health, and Agency Nursing. I have loved all aspects of nursing, but I must say I have really enjoyed being a School Nurse and feel very blessed to be at CLA." 

Kramer Nancy

Click here to see full Nurse's Profile

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