Purpose of the Immunization Policy Form
This form is used to confirm that parents or guardians understand and comply with the school's immunization policy. It ensures that the school has up-to-date immunization records for each student to promote a safe and healthy school environment. Parents or guardians must review and sign this form to acknowledge their responsibilities regarding their child’s immunizations.
Immunization Policy Acknowledgement:
By signing this form, I, the undersigned parent or guardian of the named child, acknowledge and agree to the following:
- Compliance with Immunization Requirements
I understand that the school requires up-to-date immunization records for all students as mandated by state and local health authorities. I agree to provide the school with my child’s immunization records, including any updates as new vaccinations are administered.
- Submission of Records
I understand that it is my responsibility to submit a copy of my child’s immunization record to the school prior to the start of each school year or upon request. I acknowledge that failure to provide these records may result in my child being excluded from attending school until the necessary documentation is received.
- Exemptions
If my child has a medical or religious exemption from any required immunization, I agree to submit the appropriate exemption form or letter, as required by state law, to the school. I understand that in the event of an outbreak, my child may be excluded from school to prevent the spread of disease.
- School’s Role
I understand that the school will maintain my child’s immunization records in accordance with privacy laws and will only share this information with authorized personnel or health authorities when necessary for the safety of the school community.
- Automatic Assumption in Absence of Form
I understand that if this form is not completed and signed, the school will assume that my child’s immunization records are not in compliance, which may impact their enrollment status or participation in school activities.
- Release of Liability
I release the school, its employees, and representatives from any liability or claims related to the submission or use of immunization records, provided they have acted in good faith according to this policy.
- Questions and Clarifications
Any questions or concerns regarding the school’s immunization policy, state laws, or related matters can be directed to the Main Office at:
Address
Email
Phone Number
