Forms

General 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

• Certificate of Immunization completed by a healthcare provider to include boosters of the Tdap and Meningitis vaccines. Iowa law requires boosters before the first day of school.

9th Grade

• Dental Screening Certificate

12th Grade

• Certificate of Immunization completed by a healthcare provider to include booster of Meningitis vaccine. Iowa law requires boosters before the first day of school.

Required for all Students in 7th-12th Grade Participating in Athletics

• Iowa Athletic Preparticipation Physical Examination (for students participating in athletics)
• Concussion/Brain Injury Form for Athletics (for students participating in athletics)

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