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Child's Contact & Medical Information

Child's Medical History
Is Child Allergic to Anything?
Previous Hospitalizations or Surgeries
Is your child experiencing any mental or emotional challenges?
Should child's activites be limited?

A PHYSICAL EXAMINATION must be completed and signed by a licensed physician, their authorized agent currently approved by the N.C. Board of Medical Examiners (or a comparable board from bordering states), a certified nurse practitioner, or a public health nurse meeting DHHS standards for EPSDT program. Please upload a signed and dated examination and child's IMMUNIZATION RECORD.

Upload Physical & Immunization

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Christ Lutheran Children’s Center admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities
generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and other school administered programs. 

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4519 Providence Road  *  Charlotte, NC 28226

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