Student Health Information


Indiana State Law requires students entering four-year-old preschool to have: 3 Hepatitis B, 4 DPaTs, 3 Polio, 1 Varicella (OR documentation of history of having had the chicken pox disease (month and year) with a physician's signature), 1 MMR, and 2 Hepatitis A vaccinations before the first day of school.  

Indiana State Law requires that all students in Kindergarten through 5th grade have the follwoing immunizations: 3 Hepatitis B, 5 DPaTs, 4 Polio, 2 Varicella (OR documentation of history of having had the chicken pox disease (month and year) with a physician's signature), 2 MMR, and 2 Hepatitis A vaccinations before the first day of school.

Students entering grades 6-11 are also required by law to have a MCV4 (Meningitis vaccine) and a Tdap vaccine. 2/3 HPV is recommended.

All immunizations must be noted with Day-Month-Year received.

Additional information about meningococcal vaccines (PDF)

Additional information about diphtheria, tetanus, and pertussis vaccines (PDF)



Supershot Clinic is open Mon-Tues 10am-1pm, Tues-Thurs 4-7pm, and Sat 9am-noon, 1515 Hobson Rd. Call 260-424-SHOT(7468) or visit their website:


Parents must have new doctor's orders and updated information regarding their student's health concern such as: Asthma, diabetes, allergies, heart problems, etc., every new school year.


Parents making a religious objection to any or all vaccines must have a Religious Objector form on file in the school office and signed and dated each year by the parent. Contact the school nurse to pick up the form.  The Religious Objector Form is to be submitted before the start of the school year.  A physican signature is needed for a Medical Exemption.


Indiana State Law states that a student is not permitted to attend school beyond the first day of school without a physician certificate of examination on file. Below is a form which may be used. A physician does need to sign it. A dental exam is highly recommended and the form below may be used and returned to school. An eye exam is also highly recommended. There are free eye screenings available. Please see the information below regarding this.

Students who will be participating in sports must have an annual physical. The IHSAA form (first two pages) are to be completed by the physician and returned to the school or coach prior to the first athletic practice. The St. Charles Athletic Association usually arranges for several physicians to perform physicals at school in late May or parents may schedule one with their own family doctor.

Physician Certificate of Examination form (PDF)

St. Charles Emergency Medical Care Form (PDF)

Dental Exam form (PDF)

Pre-Kindergarten Vision Screening form and directions with a list of specific optometrists (PDFs)

IHSAA  Athletic Physical Form (PDF)

Severe Allergy Action Plan Physician/Parent