C2C Preschool Health Statement Form (exclude schoolers)

Gender:(Required)
Date of Birth:(Required)
Enrollment/Start Date:(Required)

To be completed by a health care professional

1. Download/Print out the file linked here.
2. Take the printed out paper to your health care professional and have them fill it out/sign it.
3. Scan the filled out paper back into your computer.
4. Attach the scan in the field below.
Drop files here or
Accepted file types: pdf, png, jpg, jpeg, doc, docx, Max. file size: 300 MB.

    A signed affidavit from the parents or legal guardian stating that medical diagnosis and treatment conflict with the tenets and practices of a recognized religious organization of which the parent is an adherent or member.

    Date(Required)