Health Registration Forms

Immunizations

Please return completed forms to your child’s attendance center as soon as possible. Registration cannot be completed until the immunization form has been submitted.

Exemptions are recognized only for specific medical or religious purposes as recognized by the law. The student must provide a valid Iowa State Department of Health Certificate of Immunization Exemption.

Immunization Requirements

Health Forms

Required Health Forms by Grade

Required Health Forms

If you do not see your child’s grade level in the list below, then no additional health forms or immunizations are required. If you are new to the district or the state and have specific questions, please contact your school nurse or your healthcare provider.

Preschool

Certificate of Immunization to be completed by a healthcare provider.
CCACSD Physical form to be completed by a healthcare provider

Kindergarten

Certificate of Immunization to be completed by a healthcare provider.
CCACSD Physical form to be completed by a healthcare provider
Vision Screening Form
Dental Screening Certificate

3rd Grade

Vision Screening Form

7th Grade

*Meningitis booster and Tdap booster required. Update Certificate of Immunization by a healthcare provider. Iowa law requires boosters before the first day of school.

9th Grade

Dental Screening Certificate

12th Grade

*Meningococcal vaccine proof required for two doses (A,C, W, Y) or one dose if received when the student was 16 years of age or older.
Update Certificate of Immunization by a healthcare provider. Iowa law requires boosters before the first day of school. There is no grace period.

*Johnson County Public Health offers free immunizations for children, regardless of insurance status. To schedule an appointment, call (319) 356-6042.

Health Forms - Required for Athletic Participation

Medical and Medication Forms

School personnel cannot administer any medication during the school day, including prescription and over-the-counter medication, unless the authorization to administer medication form is completed. This form is also available at registration and in the school health office throughout the school year.

Diabetes Medication Self-Administration Consent Form

Diet Modification Request Form

Medication Administration Policy

Medication Self-Administration Consent Form

Medication Self-Administration Consent Form - Asthma/Epi-Pen

Medication Parental authorization form for administration of medication to students

Immunization Exemption Forms

Emergency Contacts

It is district policy that the school is supplied with an emergency number that can be called in case a child becomes ill or is injured. Emergency information can be updated during school registration or any other time during the school year. If the emergency contact is someone other than a parent or guardian, please be sure that person is aware that you have given their number as an emergency phone number. If, at any time during the school year, this information changes, notify the school immediately.

Logo Image

Logo Title

In This Section