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Health Forms and Immunization Requirements 2019-2020

 

Families with students entering the 1st or 7th grades need to submit and complete the health forms from both section I and II below. These forms will be kept, as legally required, with the student’s school records.

 

I. Report of Health Examination for School Entry - (For incoming 1st grade students only)

This needs to be completed for all incoming 1st grade students 'by their pediatrician'.

Please print this form and bring it with you to your appointment.

Health Exam Entry form:

http://www.dhcs.ca.gov/formsandpubs/forms/Forms/ChildMedSvcForms/pm171a(bi).pdf

(OR)

A “waiver” of Health Examination for School Entry -

This is to be completed for all incoming 1st  grader students by parents who do not wish to have their child receive a health examination as part of California’s school entry requirement.

Waiver form for Health Exam: http://www.dhcs.ca.gov/formsandpubs/forms/Forms/ChildMedSvcForms/pm171b(bi).pdf

 

II. Immunization Records (For incoming 1st grade students & 7th grade students) 

An immunization record (yellow card or printed list of immunizations from your child’s doctor) will need to be turned in for all 1st graders, and proof of the Tdap vaccine requirement for all 7th graders.

(OR)

Verity Academy East Bay “Waiver” form-

HSLDA secured an amendment to the bill SB 277 that now excludes the vaccination requirements for all private schools based in the home (private home schooling) which includes both private schools made up of one family and private school satellite programs for multiple families. (New law as of July 1st, 2016)

VAEB Waiver form for Immunizations

 

The deadline to submit/upload these forms will be Sunday August 18th, so if these forms are needed by any of your children this year, please print them and make an appointment now, so that you will have them completed before the due date. Late fees apply to health forms due dates as well. 

If you have any questions about these forms or requirements, you can contact Kim Nixon @ Records@VerityAcademyEB.org

Thank You!