Get the free The Student Immunization Record/Waiver Form - School District of ... - amerysd k12 wi

Submit by Email DEPARTMENT OF HEALTH & FAMILY SERVICES Division of Public Health DPH 4020L (Rev. 02/08) Print Form STATE OF WISCONSIN 252.04 and 120.12 (16) Wis. Stats. STUDENT IMMUNIZATION RECORD

How to fill out the student immunization recordwaiver

How to fill out the student immunization record waiver:

1. Obtain the necessary forms: Start by obtaining the student immunization record waiver form from your school or educational institution. This form is typically provided by the school's administration or health services department.
2. Review the instructions: Read through the instructions provided on the form carefully. Make sure you understand the requirements, deadlines, and any additional documentation that may be required.
3. Provide personal information: Begin by filling out your personal information on the form. This may include your full name, date of birth, student ID number, and contact details. Ensure that all information is accurate and up to date.
4. Indicate immunization status: The next step is to indicate your immunization status. This may involve checking off boxes or providing specific details regarding the immunizations you have received. If you have not received certain immunizations, you may need to explain why or provide a valid exemption.
5. Attach supporting documentation: Depending on your circumstances, you may need to attach supporting documentation to the form. This could include medical records, proof of immunization exemption, or medical waivers. Make sure to include all required documents to avoid any delays in the processing of your waiver.
6. Sign and date the form: Once you have completed filling out the form and attached any necessary documents, sign and date the document as instructed. By signing the form, you are confirming the accuracy of the information provided and your understanding of the waiver requirements.
7. Submit the form: After completing the form, submit it according to the instructions provided by your school. This may involve submitting it online through the school's portal, mailing it to the designated department, or hand-delivering it to the appropriate office. Follow the submission guidelines to ensure your form is received and processed in a timely manner.

Who needs the student immunization record waiver?

1. Students with documented immunization exemptions: The student immunization record waiver is primarily required for students who have valid exemptions from certain immunizations. This includes individuals who may have medical contraindications, religious beliefs, or philosophical objections that prevent them from receiving certain immunizations. The waiver allows these students to attend school while still complying with the immunization requirements.
2. K-12 students and college/university students: The student immunization record waiver is relevant for both K-12 students and college/university students. Depending on the specific educational institution, the waiver may have slightly different requirements and procedures. However, it serves the same purpose of documenting and verifying immunization exemptions for students.
3. Students transferring from another school or district: Students who are transferring from another school or district may also need to provide a student immunization record waiver. This is necessary to ensure continuity in documenting their immunization status and exemptions. Transferring students should check with their new school or educational institution for specific requirements and procedures regarding the waiver.

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What is the student immunization record waiver?

The student immunization record waiver is a form that allows students to opt out of immunization requirements for certain reasons such as medical, religious, or personal beliefs.

Who is required to file the student immunization record waiver?

Students who are unable or unwilling to comply with immunization requirements are required to file the student immunization record waiver.

How to fill out the student immunization record waiver?

The student or their guardian must complete the form stating the reason for opting out of immunization requirements and providing any required documentation.

What is the purpose of the student immunization record waiver?

The purpose of the student immunization record waiver is to provide an alternative for students who cannot receive immunizations due to medical, religious, or personal beliefs.

What information must be reported on the student immunization record waiver?

The student immunization record waiver must include the student's name, reason for opting out of immunizations, and any supporting documentation.