<p>Medical Forms & Information<br />
Required forms due by<br />
first day of attendance</p>
Medical Forms & Information
Required forms due by
first day of attendance

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 Forms
    Due on the first day of attendance
    Must be completed by your child's physician

    The Center MUST have the Children's Medical Report & Immunization History form completed by your child's pediatrician on file by the first day of school attendance.

    Children without immunizations and current medical forms on file will be excluded from the Center.

    View/download CCDC Medical Form

    Please return forms via email, fax, or in-person to the CCDC Main office on the 1st floor.

    Email: jforlenza@calvarycdc.com
    Fax: 704.341.5422 — Attn: 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 Plan Forms
    Due on the first day of attendance
    Must be completed by your child's physician

    The following form packets must be completed if your child meets the criteria. Forms must be completed by your child's physician. They are due on your child's first day of attendance at the Center.

    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 on file with the classroom teacher by first day of attendance.
    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 on file with the classroom teacher by first day of attendance.
    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: The first 2 sheets of the Food, Non-Food, & Respiratory Distress Action Plans, and the first page of the Seizure Action Plan packets must be completed by your child's physician 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 completely 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

    View/download Permission to Administer Topical Ointment/Lotion/Powder Form 

    Download and complete this form to give authorization to CDC staff to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, on your child.

    This form does not require a physician's signature. Please use one form per ointment, lotion or powder.