<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

Each enrollment year all students are required to have a number of completed medical forms on file. Please see below for details on all the key required forms. 

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

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    Medical Form | Required for every student
    Due within 30 days of enrollment
    Must be completed by your child's physician

    Medical Form | Required for every student enrolled
    Due within 30 days of enrollment
    Must be completed by your child's physician

    View/download Infant & Toddler Medical Form

    Please return via email, fax or in-person to the Infant & Toddler office.
    Email: ktasker@calvarycdc.com; Attn: Kim Tasker/Infant & Toddlers
    Fax: 704.887.3676

    View/download Ages 2-Kindergarten Medical Form

    Please return via email, fax or in-person to the Infant & Toddler office.
    Email: jforlenza@calvarycdc.com; Attn: Julie Forlenza/Preschool Office
    Fax: 704.341.5422


    Helpful Additional 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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    Allergy/Asthma/Seizure Forms
    Must be completed by your child's physician
    Must be on file by first day of attendance

    Allergy/Asthma/Seizure Forms
    Must be completed by your child's physician
    Must be on file by first day of attendance

    The following form packets must be completed if your child meets the criteria.

    Form Packet Criteria
    Food Allergy Action Plan For students with food allergies that require medication (Benadryl, Epi-Pen) 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 (Benadryl, Epi-Pen) 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.
    Asthma Action Plan For students who have asthma
    Seizures Action Plan For students who have seizures


    NOTE: The first 2 sheets of the Food, Non-Food, & Asthma 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.