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

HEALTH
DASHBOARD

Medical
Forms

Dental Form 23-24Download
Hemoglobin Screening Letter Parent 23-24 docxDownload
Hemoglobin Screening Letter Parent 23-24Download
Immunization Letter Physician Letter 23-24 docxDownload
Parental Declination of Child Vaccination 23-24Download
Right to Refuse Services 23-24Download
WELL CHILD EXAM 23-24 No HighlightDownload
Family Services Referral Form 23-24Download
Medical Statement Food Allergy Restriction Plan 23-24Download
TB TDAP Form 23-24Download

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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.