Central Lyon Health Forms
ALL STUDENTS
*All health forms should be submitted directly to the office or by email to bvanhofwegen@centrallyon.org
- Health HX Registration Form
- Medication Authorization Form (For medications brought from home to be given at school)
- Immunization Requirement Table
- Immunization Requirements (Iowa Department of Public Health version)
- Provisional Certificate of Immunization
- Medical Immunization Exemption Form
- Religious Immunization Exemption Form
ADDITIONAL FORMS
*To be completed by medical providers. All health forms should be submitted directly to the office, faxed to 712-472-2115 or emailed to bvanhofwegen@centrallyon.org
- Allergy & Anaphylaxis Emergency Plan
- Asthma Action Plan
- Authorization to Carry Inhaler
- Certificate of Dental Screening - Required for Kindergarten and 9th Grade. To be completed by dentist.
- Certificate of Vision Screening - Required for Kindergarten and 3rd Grade. To be completed by eye doctor.
- Diet Modification Form
- Diabetes Medical Management Plan
- Seizure Action Plan
ATHLETIC FORMS
*Athletic forms need to be submitted on Bound
- Athletic Physical
- Supplemental Student Accident Insurance
- Informational Letter
- Student Assurance Services Flyer
- SAS Enrollment Form
- Questions maybe directed to:
- Lisa Dieren
- Email: LisaD@frontieragency.com
- Phone: 712-472-3551
- Sonny Heinrich
- Email: sonnyh@sas-mn.com
- Phone: 800-328-2739
- Lisa Dieren