Health Forms and Requirements

The following state-required forms must be submitted to complete Stage 2 of Registration:

For children going into Nursery:

  • Copy of the Birth Certificate
  • Medical Form with health history completed signed by a parent
For children going into Kindergarten/Pre-1A:

For children going into 2nd Grade:

For children going  into 6th Grade:

For new students K- 8:

  • Copy of Birth Certificate
  • Medical Form with health history completed signed by a parent
  • Eye Form (Only required if the student is moving from out of Illinois)
  • Dental Form (Only required if the child is going into Kindergarten/Pre-1A, 2nd or 6th Grade)

Click here to download the Dental Waiver
Click here to download the Eye Waiver
Click here to download the Emergency Action Plan (MAP) Form
Click here to download the Asthma Action Plan Form

Health forms can be submitted in any of the following ways:

  1. Uploaded to our registration portal – visit, after logging in, click on the forms upload tab
  2. Emailed to
  3. Faxed to 773-465-8982
  4. Mailed to the JDBY-YTT Business Office at 6122 N. California Ave. Chicago IL 60659
  5. Dropped in the Business Office Mailbox located outside of 6122 N. California Ave.

For any questions regarding the Health Forms and Requirements please contact our School Nurse, Mrs. Chaya Siegal at or 773-465-8889 ext. 645 or our Assistant Nurse, Mrs. Aliza Olswang at 

Please Note:

  • Dental form must be from an exam performed on or after November 1, 2019
  • Eye exam form must be from an exam performed on or after September 3, 2019
  • Medical forms must be from an exam on or after September 1, 2019 and with health history completed and signed by a parent

The policy of the school is for all students to have all state-required vaccinations and immunizations. Only state-recognized medical exemptions will be considered for exceptions, and must be submitted and accepted by the school prior to admittance.