Emergency Notice

Emergency Notification

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Caroline Bentley
Intermediate School
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Mrs. King
Nurse - Bentley


If your child will require daily and/or emergency medications during the 2020-2021 school year, please have a district medication authorization form completed for EACH medication. Page one requires a physician to complete, page two is for parents to complete. This form applies to all prescription and over the counter medications.

For inhalers only: ONLY page 2 of the medication authorization needs to be completed by a parent or guardian. An asthma action plan should be completed by your child's physician. Below is a link to the recommended form but we will also accept a form that is preferred by your child’s medical provider.

Food allergies: Students with food allergies must have an Illinois Food Allergy Emergency Action Plan and Treatment Authorization Form on file with the school nurse. The form must be completed by a licensed health care provider and the parent/guardian. It is the parent/guardian responsibility to submit the form and the emergency medication to the school health office prior to the student attending school. 

Medication authorization form:http://www2.nlsd122.org/files/district/parentsandstudents/medical/medication_authorization_form.pdf

Asthma action plan:  http://www2.nlsd122.org/files/district/parentsandstudents/medical/asthma_action_plan_isbe.pdf

Illinois Food Allergy Emergency Action planhttp://www.nlsd122.org/files/district/parentsandstudents/medical/food_allergy_emer_action_plan.pdf


In order to prepare for the 2020-2021 school year, all students entering 6th grade are required to have the following on file prior to October 15, 2020. 

  • A complete physical exam form signed by a licensed physician and dated within one year before the start of the school year.
  • One dose of Tdap vaccine (Td is acceptable in place of Tdap if a medical contraindication to pertussis exists).
  • One dose of Meningococcal vaccine given on or after the child’s eleventh birthday.
  • A completed Hepatitis B series. Many children have already had this series of vaccines by the time they are entering sixth grade. Please contact the school nurse or your child’s physician if you have questions regarding immunization records. 

If these documents, or religious/medical exemption forms, are not received by October 15, 2020, your child will be excluded from school until all documents are received.

An oral health examination form signed by a licensed dentist is also required for students entering sixth grade. This form is due no later than May 15, 2021 and must have been completed within the 18 months prior to the May 15th deadline. Any exam done on or after November 15, 2019 is acceptable.

Physical exam form: http://www.nlsd122.org/files/district/parentsandstudents/medical/physical_exam_form.pdf

Religious exemption form: http://www.nlsd122.org/files/district/parentsandstudents/medical/religious_objection_form_2015.pdf

Dental exam form: http://www2.nlsd122.org/files/district/parentsandstudents/medical/dentalexamproof.pdf

dental exam waiver: http://www2.nlsd122.org/files/district/parentsandstudents/medical/2014-2015denatlexamwaiver.pdf



Visit Myplate.gov for important nutrition information as well as activities for kids, how to eat healthy on a budget, and healthy recipes for families!


For more health and safety topics related to kids and teens, visit: http://kidshealth.org/en/kids