Emergency Contacts, Immunizations and Health Insurance

Incoming students are required to submit the following form(s). Your proof of immunization must be on file with Health Services prior to the first semester's first day of class. Failure to provide this information will result in cancellation of your registration.

Download Forms

Emergency Contact, Immunizations and Health Insurance Form  (pdf)

Immunizations Exemption Form  (pdf)
Medical Exemption: Your physical condition is such that immunization would endanger life or health, or is medically contraindicated due to other medical conditions.
Religious Exemption: Certify your conscientious or religious objection to immunizations. Must be notarized.


Return completed forms to:

Mount Mercy University
Health Services Office
1330 Elmhurst Dr. NE
Cedar Rapids, IA 52402