Immunization Forms

Immunizations

Minnesota Statues 121A.15 and Minnesota rules art. 4604.100 require that all children who are enrolled in a Minnesota school be immunized. These requirements can be waived for two reasons:

1. Medical: This needs physician’s signature stated that your child should not get all or a particular vaccine
2. Non-Medical: Parent/Guardian is opposed to all or a particular vaccine. Parent/Guardian signature needs to be witnessed by a notary.

The school is required to have all student’s immunization information on file BEFORE the school year begins. Your child may not begin the school without the immunization information on file.

Kindergarten entrance

1. 5 DTap (5th shot not needed if 4th was after age 4)
2. 4 polio (4th not needed if 3rd shot was after age 4)
3. Hepatitis B
4. 2 MMR
5. 2 Varicella ( shot not required if child has already had chicken pox disease)

7th grade students

1. All Kindergarten vaccines must be completed
2. 1 Tdap
3. Meningococcal- One dose is required for 7th grade, a second dose at age 16 (10th/11th grade)

12th grade

1. 2nd dose of Meningococcal is needed before starting school.