Elkhart and St. Joseph Counties Head Start Consortium
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Health Medical Forms

HEALTH
DASHBOARD

Medical
Forms

Dental Form 24-25Download
Hemoglobin Screening Letter Parent 24-25Download
Immunization Letter Physician Letter 24-25 docxDownload
Parental Declination of Child Vaccination 24-25Download
Right to Refuse Services 24-25Download
WELL CHILD EXAM 24-25Download
Family Services Referral Form 24-25Download
Medical Statement Food Allergy Restriction Plan 24-25Download
TB TDAP Form 24-25Download

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The Head Start Program is a federally funded school readiness program that offers cognitive, social, and emotional development skills to children up to five years old. Head Start provides services to low-income families located in Elkhart and St. Joseph County schools including; Baugo, Concord, Elkhart, Goshen, John Glenn, Middlebury, Mishawaka, Penn-Harris-Madison, South Bend, Union North, and Wa-Nee, Indiana.