Reminder:

• State law requires students meet certain age/grade immunization requirements.
• Utilize this form to update your child's immunization record with the school.
• If for health reasons, religious reasons or for personal conviction reasons you wish NOT to have your child immunized; fill in Step 4 of this form, to officially waive these requirements.  This must be on file with the school to meet legal obligations.
• For the 2017-18 school year immunization requirements, click the following link or see the school newsletter.

http://www.dhs.wisconsin.gov/immunization/reqs.htm

STUDENT IMMUMIZATION RECORD/WAIVER:

http://www.dhs.wisconsin.gov/forms/F0/F04020L.pdf