<p>Medical Forms & Information<br />
Required for all students<br />
<em>Due by August 1</em></p>
Medical Forms & Information
Required for all students
Due by August 1

Medical Forms & Information

All students are required to have current medical forms on file. Please see the details on required forms below. 

Please note: The information on this page does not cover every aspect of our illness policy. Please see the CCDC Parent Handbook for more information.

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    Required Medical Form
    DUE by August 1
    Must be completed by your child's physician

    The Center MUST have your Children's Medical Report & Immunization History form, completed by your child's pediatrician, on file by August 1 (or the first day of school attendance if joining the program mid-year). Children without immunizations and current medical forms on file will be excluded from the Center.

    Download the required form below. Complete the PDF and return it via email, fax, or in-person to the CCDC Main Office.

    CHILDRENS MEDICAL REPORT & IMMUNIZATION HISTORY

    Email jforlenza@calvarycdc.com
    Fax 704.341.5422 to Julie Forlenza / Business Office


    Additional Helpful Information: Summary of Vaccine Requirements


    Legal Requirement from the NC Department of Health & Human Services: 

    "No child shall attend a child care facility as defined in G.S. 110-86(3), unless a certificate of immunization indicating that the child has received the immunizations required by G.S. 130A-152 is presented to the school or facility. Anyone who is not age-appropriately vaccinated on the first day of attendance shall have 30 calendar days to obtain the required immunizations. Upon termination of 30 calendar days or the extended period, the operator shall not permit the child to attend the facility unless the required immunizations have been obtained."

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    Medical Action Plans
    Forms 
    DUE by August 1
    Must be completed by your child's physician

    The following form packets must be completed if your child meets the criteria for a Medical Action Plan. Your child's physician must complete forms. They are due by August 1 (or the first day of school attendance if joining the program mid-year).

    Form Packet Criteria
    Food Allergy Action Plan For students with food allergies that require medication to be administered in the event of contact or ingestion of an allergen. NOTE: Students who use Epi-Pens must have TWO pens at CCDC by August 1.
    Non-Food Allergy Action Plan For students with non-food allergies that require medication to be administered in the event of contact or ingestion of an allergen. NOTE: Students who use Epi-Pens must have TWO pens at CCDC by August 1.
    Respiratory Action Plan For students who have respiratory medication or asthma
    Seizures Action Plan For students who have seizures
    General Medical Action Plan For students who have health care needs that require specialized health services


    NOTE: Your child's physician must complete the first two sheets of the Food, Non-Food, & Respiratory Distress Action Plans and the first page of the Seizure Action Plan packets, AND both parents/legal guardians & physician must sign and date the pages.

    • The remaining page must be filled out by the parent(s)/legal guardians.
    • All forms in these packets must be signed, dated, and filled in.
    • They must be updated every six months or any time there is a change in the medical condition or medication.
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    Permission to Administer Topical Substances
    Does not require a physician's signature

    PERMISSION TO ADMINISTER TOPICALS FORM

    Download and complete this form to give CCDC staff authorization to apply over-the-counter medications such as topical ointments, topical teething ointment/gel, insect repellents, lotions, and creams (including sunscreen, diapering creams, and baby lotion) on your child.

    This form does not require a physician's signature. Please use one form per medication/product.

    All products must be provided in the original packaging with an expiration date and clearly labeled with your child’s name. Products must be given to the school nurse at the Main Office. Teachers cannot accept any medications in the classroom. Remember, sunscreen and diaper cream are considered medications. Thank you!