School Life
Health Clinic

Middle School Health Forms

Incoming students grades 6-8 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 the Middle School by August 1, 2021.
  1. The State of Florida School Entry Health Examination Form (DH3040) must be completed by your child’s doctor within a year from the time school begins. We can accept an Out of State Physical (DH3040), as long as the date is one year prior to the new school year.
  2. In addition to the DH 3040, all 3 pages of The Preparticipation Physical Evaluation EL2- FHSAA must also be completed by your child’s physician before they can participate in school sports. Please click on the blue text to open and print forms and bring it with you when you have your child’s physical. Parents must also complete all 4 pages of the FHSAA EL3 forms.
  3. Completed Florida Certificate of Immunization (#680) – Student immunizations must be in compliance with the State of Florida’s requirements. All 7th grade students who have not yet received their Tdap booster must meet this requirement before entrance to school.
  4. 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.
We appreciate having your forms as soon as you have them completed, but they MUST BE IN THE MIDDLE  SCHOOL OFFICE BY AUGUST 1,  2021. 

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 the clinic at 561.472.3427.  Thank you in advance for your cooperation.
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.
After hours emergency contact:
Leslie Downs/Chief Operating Officer
Ph:  561.657.0075 or 561.747.0585