Kealing Middle School Varicella Verification Form free printable template

CHILDREN S/AID STUDENT HEALTH SERVICES VARICELLA VERIFICATION FORM DATE: TO: School Parents of DOB: FROM:, Student Health Services Health Team Phone: RE: FAX: Varicella Exemption (Proof of Chicken

How to fill out kealing varicella verification printable

How to fill out Kealing Middle School Varicella Verification Form

1. Obtain the Varicella Verification Form from Kealing Middle School's website or the school's administrative office.
2. Fill out your child's personal information at the top of the form, including full name, date of birth, and grade level.
3. Provide detailed vaccination history by entering the date(s) of the Varicella (chickenpox) vaccine your child has received.
4. If applicable, indicate if your child has a history of chickenpox disease and provide the approximate date of the illness.
5. Sign and date the form at the bottom to verify that the information is accurate.
6. Submit the completed form to the school’s health office either in person, via email, or through the school's online submission system.

Who needs Kealing Middle School Varicella Verification Form?

1. All students enrolling in Kealing Middle School are required to submit the Varicella Verification Form to prove they have received the Varicella vaccination or have a history of chickenpox disease.

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What is Kealing Middle School Varicella Verification Form?

The Kealing Middle School Varicella Verification Form is a document used to verify a student's vaccination history regarding varicella, commonly known as chickenpox.

Who is required to file Kealing Middle School Varicella Verification Form?

Parents or guardians of students who are enrolling in Kealing Middle School and have either not received the varicella vaccine or have had the disease must file the form.

How to fill out Kealing Middle School Varicella Verification Form?

To fill out the form, you need to provide the student's information, vaccination history, and any medical evidence demonstrating past infection or vaccination against varicella.

What is the purpose of Kealing Middle School Varicella Verification Form?

The purpose of the form is to ensure that all students are either vaccinated against varicella or have a documented history of the disease, thereby maintaining the health and safety of the school population.

What information must be reported on Kealing Middle School Varicella Verification Form?

The form must report the student's name, date of birth, vaccination dates, and any medical records that confirm previous varicella infection or vaccinations.