School Life
Health Clinic
Health Forms
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Incoming students are required to meet state immunization and Health Examination requirements. The ORIGINAL FORMS are provided and completed by your child’s doctor. The following forms must be returned to Lower, Middle and Upper School nurses by August 1.
Lower School Students WOW-5th grade
these forms are required for all new incoming students of any grade level and all WOW, PK and Kindergarten students.
these forms are required for all new incoming students of any grade level and all WOW, PK and Kindergarten students.
1. The State of Florida School Entry Health Examination Form (DH3040) must be completed by your child's doctor and dated within one year of enrollment. STATE OF FLORIDA School Entry Health Exam. * We will accept an out-of-state physical, as long as the date is one year prior to the new school year and contains the same information. New students from out of the country must complete their health examination in the US, preferably in Florida and dated within one year of the start of school. All forms must be completed in the English language.
2. Completed Florida Certificate of Immunization (#680) – Student immunizations must be in compliance with the State of Florida’s requirements. Out of state and out of the country immunization records must be transcribed onto the Florida 680 form by a local pediatrician, urgent care, or the Florida Department of Health. Must be completed in the English language.
3. If you are coming from out of state, we must have your child/children’s immunizations on a Florida 680 form. This can be done by a Florida Pediatrician, Florida Urgent Care, or the Florida Health Department. Bring a copy of your child’s immunization and they will transcribe the immunization information onto the necessary forms.
Middle School Students
All NEW MS students and all 7th grade students need the following health forms.
All NEW MS students and all 7th grade students need the following health forms.
1. The State of Florida School Entry Health Examination Form (DH3040) must be completed by your child's doctor and dated within one year of enrollment. STATE OF FLORIDA School Entry Health Exam. * We will accept an out-of-state physical, as long as the date is one year prior to the new school year and contains the same information. New students from out of the country must complete their health examination in the US, preferably in Florida and dated within one year of the start of school. All forms must be completed in the English language.
2. Completed Florida Certificate of Immunization (#680) - Student immunizations must be in compliance with the State of Florida requirements that include a tdap booster
http://flshotsusers.com/parents-guardians. Out of state and out of the country immunization records must be transcribed onto the Florida 680 form by a local pediatrician, urgent care, or the Florida Department of Health. Must be completed in the English language.
3. ATHLETICS: All MS students that participate in school athletics must complete either the DH3040 STATE OF FLORIDA School Entry Health Exam OR the EL2 Participation Physical (EL2) ... dated after August 1st
Upper School Students 9th-12th grade
the following forms are required for all NEW incoming students.
the following forms are required for all NEW incoming students.
1. The State of Florida School Entry Health Examination Form (DH3040) must be completed by your child’s doctor and dated within one year of enrollment. STATE OF FLORIDA School Entry Health Exam. * We will accept an out-of-state physical, as long as it is within one year from enrollment and contains the same information as the Florida form. New students from out of the country must complete their health examination in the US, preferably in Florida and dated within one year of the start of school. All forms must be completed in the English language.
2. Completed Florida Certificate of Immunization (#680) - Student immunizations must be in compliance with the State of Florida's requirements.http://flshotsusers.com/parents-guardians. Out of state and out of the country immunization records must be transcribed onto the Florida 680 form by a local pediatrician, urgent care, or the Florida Department of Health. Must be
completed in the English language.
3. ATHLETICS - All US students who participate in school athletics must complete either the DH3040 STATE OF FLORIDA School Entry Health Exam OR the EL2 Participation Physical (EL02) - and dated within one year of the previous physical exam. These forms are uploaded online directly to the Athletics Department.”
We appreciate having your forms as soon as you have them completed, but they MUST BE IN DIVISION OFFICES BY AUGUST 1. Under state law your child will not be allowed into class or to participate in sports without these forms.
If you have any questions, please contact our clinics:
Lower/Middle School 561.472.3427
Upper School 561.472.3448
Lower/Middle School 561.472.3427
Upper School 561.472.3448
Main Address & Lower/Middle School
11000 Ellison Wilson RoadNorth Palm Beach, FL 33408
Ph: 561.626.3747
A premier PK3 - Grade 12 independent, coeducational day school with campuses in North Palm Beach and Palm Beach Gardens. Since 1960, The Benjamin School has provided a challenging college preparatory education to a diverse student body in a structured, nurturing community environment.