Dear Parent or Guardian:

If your child is entering any of the following grades, please note the medical forms needed. The physical and immunization record must be brought in at registration or by the first day of school or your child will not be allowed to start school.

K or new students to the district:

Physical examination
Immunization record
- Polio: 4 doses with the last dose after the 4th birthday
- Diphtheria, Tetanus, Pertussis: 4 or more doses with the last dose after the 4th birthday
- Measles, Mumps, Rubella: 2 doses with the first at 12 months of age and the second at least one month later
- Hepatitis B: 3 doses
- Varicella (Chickenpox): 2 doses or proof of having disease
Proof of lead screening or blood test
Dental examination
Vision examination
Birth certificate: copy from the county courthouse in the county which your child was born, this is not the certificate from the hospital

2nd grade - Dental Exam

6th grade -Physical, Tdap Vaccination, Meningococcal Vaccination, Dental Exam

9th grade - Physical, Tdap Vaccination (regardless of date of last tetanus), Dental Exam

12th grade -2 doses of Meningococcal Vaccination, if first dose administered after the age of 16, then one dose is required for school entry.

I appreciate your cooperation in keeping our school safe and healthy. If I may be of any assistance or if you have any questions, feel free to call me at 676-1521, ext. 333.

Thank you,

Stacy Withrow, School Nurse

PLEASE NOTE: No medication (even over the counter medication like Tylenol, Tums, Ibuprofen, etc.) will be given to a student without a signed "Permit to Give Medication" form on file.

Clay City CUSD #10