Sports/Activities Physical Form
Medical Forms
Medical Immunization Exemption Form.pdf
Religious Immunization Exemption Form.pdf
Self Medication Administration Consent (for emergency Epi-Pens, inhalers, insulin and glucagon ONLY)
Allergy Action Plan.pdf
Medication - Parent Permission.pdf
Student Health Update.pdf
EpiPen Authorization and Release Form.pdf
Diet Modification Form.pdf
Dental Screening Form.pdf
3rd Grade Vision Screening Form
Kindergarten Physical & Immunization Form.pdf
Statement of Exemption to Immunization Law.pdf
Blood Lead Test
A recent state law requires all Iowa children under the age of six to have at least one blood lead test and one dental screening before enrolling for school. The blood lead test is the only way to know if your child is lead poisoned. Your lead-safe child will perform well in school and make good decisions. Insist on this test from your physician. The test is covered by insurance. If you do not have a physician, contact the Black Hawk County Health Department at 319-291-2413 for the locations of free testing sites. Get ALL YOUR CHILDREN under the age of six tested for lead. Ideally, you should test your children at ages one and two. Children living in hazardous homes should be tested more often.
Dental Screening
A dental screening should be done at your child's next physical examination or at a dentist's office. If you don't have a dentist or insurance, contact the I-Smiles Program at 319-291-2413 to learn more about free dental screenings.
Dental Screening Form.pdf
Physical Exam and Health History
Our Board of Education policy also requires that your child have a complete physical examination before entering preschool. A health history including specific health needs may also be required.
Voluntary Student Accident Plan.pdf
Voluntary Online Form.pdf
Spanish-Voluntary Online Form.pdf
Iowa Code, Chapter 139a.8(6) and Iowa Administrative Code, 641-7.7(139) outline the immunization requirement for students attending Iowa schools. Students must have received the required immunizations or have a valid Certificate of Immunization Exemption or a Provisional Certificate of Immunization prior to attending school. For more information about which immunizations your child needs or how to obtain an exemption, please visit the Iowa Department of Health website here or contact your school nurse.