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Grade Level Mandatory Immunization

  • Grade Level Mandatory Immunization.
  • The immunization record is obtained from your health care provider and must be signed and stamped by a healthcare provider.
  • If necessary, please have your NYS healthcare provider translate your child’s record.
  • Please return or E-mail completed forms to the school nurse.
Immunization Records
  • The certificate of immunization shall be prepared and signed by a healthcare provider licensed in New York State and must specify the vaccines administered and the exact dates of administration. A record issued by NYSIIS, the CIR, an official immunization registry from another state, an electronic health record, and /or an official record from another country may be accepted as a certificate of immunization.
  • Must be received within 14 days of the first day of school, or your child will be excluded from attending school.
  • For students entering the district from another country, this record must be received within 30 days of the first day of school, or your child will be excluded from attending school.
  • If your child does not meet all of the New York State mandated vaccination requirements for school entry, they will need to follow the New York State ACIP Recommended Catch Up Schedule and receive any missing vaccines within 14 days of the minimal interval. Documentation of any vaccines received must be brought to the school nurse.
  • Click here to download the New York State Mandated Immunizations for School Entry and the New York State Recommended Catch Up Schedule.
  • If you have any questions regarding your child’s immunization status, please do not hesitate to contact your child’s nurse prior to any upcoming appointment with their pediatrician.

 Immunization Medical Exemption Form
  • If a student has a medical exemption to a vaccination, a physician licensed to practice medicine in New York State must complete, sign and stamp this form. This form must be reissued annually.

 Form Instructions for Printing