Sample Parent Letter Template Requesting Immunization Records printable pdf download

Sample Parent Letter Template Requesting Immunization Records

Sample parent letter requesting immunization records.

School Letterhead

Date

Dear Parent/Guardian;

A review of the Student Health Record of ______________________________

(Student Name)

has found that there is no record of or the record is incomplete for the following

immunizations that are required by Maine State Law for enrollment in school.

___ DPT/DtaP/DT/Td (diphtheria, pertussis, tetanus) _____ OPV or IPV (Polio)

___ MMR (measles, mumps, rubella)

_____ Chickenpox (Varicella)

These records must be received by ______________________. Please bring,

send or fax a copy of the immunization record to the school by this date. Maine

State Law allows for a one-time 90-day period from the time of school registration

and allows for 21 days to transfer health records for a student enrolling in a new

school. Following this time period, the superintendent is not permitted by state

law to allow students to attend school who are not adequately immunized and an

exclusion notice will be sent to you.

There are two exceptions.

1. If the student’s physician believes the immunizations are medically

inadvisable, a written statement to that affect signed by the physician must

be given to the school each school year.

2. If you have a religious or philosophical objection to immunizations, you

must write a statement indicating your objections and provide to the

school each school year.

Please be aware that students, who have a waiver of immunization either for

medical or religious or philosophical reasons, will be excluded from school if

there is an outbreak of a disease for which the student is not immunized.

School nurse

Phone and Fax #

Sample Parent Letter Template Requesting Immunization Records