Heather Collins, RN BSN
Sigourney CSD Nurse
Phone: 641-622-2350
Fax: 641-622-3604

Immunizations: Iowa Department of Public Health Certificate of Immunization

Religious Exemption: Iowa Department of Public Health

Medical Exemption: Iowa Department of Public Health

Physical Form (Non-Athletic)

JH/HS Athletes: Required Heads Up Concussion Form

Heads Up Concussion Information

JH/HS Athletes: Required Physical Form

OTC Medication Form

Long Term Medication Form

Self-Administration Medication Form

Diet Modification Request Form

Vision: Iowa Child Vision Screening Program

Dental: OHDS – School Dental Screenings

Kindergarten Packet

Preschool Packet

Food Allergy & Anaphylaxis Emergency Care Plan

Asthma Action Plan

Seizure Action Plan

COVID-19 and K-12 School Update: Fall 2022 School Update

Head Lice: Head Lice, Lice – Head Lice

Cold Vs. Flu: Cold Versus Flu

Concussions: Page 5

K-12 School Health Requirements

• Preschool: Parents must provide proof student has received:

  • Immunizations

    • 4 doses Diphtheria/Tetanus/Pertussis (Tdap)

    • 3 doses of Polio

    • 3 doses Hepatitis B

    • 4 doses of Pneumococcal if 3 doses received <12 months of ages, or 3 doses if received 2 doses <24 months of age, or 2 doses if received 1 dose < 24 months of age or 1 dose if received no doses <24 months of age

    • 1 doses Measles/Mumps/Rubella (MMR).

    • 1 doses Varicella

  • Physical Assessment Form: A physical exam must be completed by a health care provider and a copy provided to school by the parent prior to the first day of school.

• Also required, copies of:

  • Birth certificate

  • S.S. card

• Kindergarten: Parents must provide proof student has received:

  • All 4 year old booster immunizations: Tdap, Polio, MMR, and Varicella

  • Vision Screening completed at a Health Physical, by Lion’s Club, or a Family Optometrist. (No earlier than 1 year prior and no later than 6 months after enrollment.)

  • Dental Screening at a Health Physical or by a dental provider (No earlier than age 3 and no later than 4 months after enrollment).

  • Physical Assessment Form: not required but highly suggested

• Also required, copies of:

  • Birth certificate

  • S.S. card

    **only if student has not previously attended preschool with our district

• 3rd Grade student: Parents must provide proof student has:

  • Vision Screening completed at a Health Physical, by Lion’s Club, or a Family Optometrist. (N

    o earlier than 1 year prior and no later than 6 months after enrollment)

• 7th Grade (and older) student: Parents must provide proof student has:

  • Tdap vaccination

  • Meningococcal vaccination on or after 10th birthday

• 9th Grade student: parents must provide proof student has:

  • Dental Screening performed by a licensed dentist or dental hygienist. IDPH dental screening form must be completed and returned to the school office or nurse. (N

    o earlier that 1 year prior and no later than 6 months after enrollment.)

• 12th Grade student: parents must ensure student has:

  • Received 2 doses of Meningococcal vaccine; or 1 dose if first dose was received at 16 years of age or older

Parents with students in these specific school grades are encouraged to schedule appointments with appropriate provider(s) in the summer before entering the specific school grade. Please print off required form(s), found on the left, to take to the appointment. Forms can be faxed to the school nurse at 641-622-3604. These requirements must be completed before the first day of school.

Medication Requirements

Prescription Medications: If you child will need prescribed medications (i.e. Inhalers, Ritalin, etc.) administered at school during the school year, please have your physician sign an order for the medication to be administered at school. This includes any short-term medicine like antibiotics. All prescription medications must be in the original bottle from the pharmacy.

Non-prescription Medication: If your child will need an over-the-counter medication to be administered at school the parent/guardian must provide the medication to the school in the original container and sign a permission form for the nurse or trained staff to administer the medication.

Over the counter (OTC) medications
Parental Permission for over the counter medication is addressed when you register student via Infinite Campus. Please see form below for a list of OTC medications that can be used at school.

Diet Modification
If your student has a medical diet modification you will need to have a form signed by your physician. Forms can be found here. This is a requirement of the United States Department of Agriculture. Please work with the school nurse to ensure all of the students dietary requirements are met.

First Aid at school
Small cuts, scrapes or abrasions will first be cleaned. A triple antibiotic may then be applied and covered with a band aid. Rashes that itch and bug bites may be treated by applying an anti-itch cream such as Callergy Clear or Hydrocortisone 1% cream. Please contact the school nurse if you do not want triple antibiotic cream, Callergy cream or Hydrocortisone 1% cream applied to your child. Open or draining wounds must be covered with a gauze bandage or band aid.

ILLNESS POLICY AND EXCLUSION OF SICK CHILDREN
For the health and safety of all the children, it is mandatory that sick children not be brought to school. If your child has any of the following symptoms during the night, he or she will not be admitted the following morning for the safety of the other children.

• Fever greater than 100 degrees F

• Vomiting

• Diarrhea

• Pink eyes with drainage

• Cough with congestion and excessive nasal discharge

The district's established policy for an ill child’s return:

• Fever free for 24 hours

• Chicken pox: one week after onset (or when lesions are crusted)

• Strep: 24 hours after initial medication

• Vomiting/Diarrhea: 24 hours after last episode

• Conjunctivitis (Pink Eye): 24 hours after initial medication or when without drainage