According to Connecticut State Law, students must provide specific, mandated health information before being permitted to enter school. Please review the completed health assessment forms for the following information:

1.  Physical examination dated within one (1) year of school entry completed and signed by physician.

2.  Copy of immunization record from physician’s office.

3.  Proof of immunization requirements must provide day, month and year of each vaccine.

a. Four doses of DPT (Diphtheria, Pertussis, Tetanus); Last dose must be on or after the 4th birthday and before school entry. Note from physician indicating medical contraindication when pertussis omitted or deferred.

b. Three doses of Polio; Last dose must be on or after the 4th birthday and before school entry.

c. 1 HIB (Haemophilus Influenza Type b); For children under 5 years. One dose at 15 months or older, or physician’s signed statement verifying history of disease at 24 months or older based on blood test.

d. Measles; 1 dose given after 12 months old or blood test verifying evidence of past infection. Entering Kindergartners and 7th graders must show proof of 2 doses at least 30 days apart.

e. Mumps; 1 dose given after 12 months old or blood test verifying evidence of past infection.

f. Rubella; One dose given after 12 months old or blood test verifying evidence of past infection.

g. Hepatitis b; Three dose series or blood test verifying evidence of past infection for students born after January 1, 1994. Students entering 7th grade must document at least one (1) dose or blood test verifying evidence of past infection. Students entering 8th grade must show 3 doses of Hep.B.

h. Varicella vaccine; All students born 1-1-97 or later and those entering 7th grade are required to show immunity to Varicella (Chickenpox) before entry in school. Proof of immunity includes any of the following:

• documentation of immunization;
• or serologic evidence of past infection;
• or a statement indicating that the child has already had Chickenpox (based on family and/or medical history) which is signed and dated by a physician, physician assistant or advanced practice registered nurse.

Exemptions:

If there is a specific reason why the examination or immunization can not be done, please contact the school nurse for information about medical or religious exemptions.