Chevy Chase Presbyterian Church
CCPC
Nursery School
Resilience Creativity Exploration Kindness Community
Our Forms
2020 - 2021 School Year
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DC Oral Health Assessment (required for students age 3 and older)
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DC Medication and Medical Procedure Treatment Plan (only required for students who require medication or treatment at school)
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Action Plan for Anaphylaxis (only required for students with a diagnosed allergy)
Please submit your completed forms as pdf files to CCPCforms@gmail.com
* Please Note:
The DC Universal Health Certificate contains a section regarding risk assessment for tuberculosis (TB). Many children do not require the Tuberculin Skin Test (TST) for TB.
Your doctor should conduct a tuberculosis exposure risk assessment first, and only administer the TST if indicated in accordance with American Association of Pediatrics Guidelines. If your child does not need a TST, the doctor may simply check the low risk box and initial the form there, in addition to signing at the bottom.