Get Ccl358 Form

The Ccl358 form, utilized by the Kansas Department of Health and Environment, gathers essential health information for children and youth attending school age programs. This guide will provide you with clear, step-by-step instructions on how to fill out this form online, ensuring that you meet all necessary requirements.

Follow the steps to fill out the Ccl358 form online.

1. Click the ‘Get Form’ button to obtain the Ccl358 form and open it in the online editor.
2. Begin filling out the children's basic information. This includes gender, full name, and date of birth. Make sure to input the date in MM/DD/YYYY format.
3. Provide the first day your child will attend the program along with the names and addresses of their guardians. This includes both mothers’ and fathers’ contact details, ensuring all sections are filled accurately.
4. List the names and ages of any other siblings in the child's family. If you need more space, you can attach an additional page.
5. Note the authorized individuals who can pick up your child in case of emergencies. Include their names and addresses, along with a working phone number.
6. Fill in the physician's name and address, and indicate any hospital preferences for emergency situations.
7. Answer questions regarding your child's medication needs. If they will require any medication during the program, confirm that a signed permission slip is on file.
8. Indicate any known health conditions or allergies that may affect the child while attending the program. This information is vital for the staff to provide proper support.
9. Fill out the immunization history section. Confirm whether the child attended a public or accredited non-public school in the previous year and check their immunization status.
10. If your child has not yet attended a qualifying school, provide the dates of all required immunizations in the designated fields.
11. Complete the final section by printing your name and signing the form, indicating your relationship to the child and the date of completion.
12. Once all sections are completed, you can save your changes, download, print, or share the form as needed.

Complete your Ccl358 form online to ensure your child is ready for school age programs.