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Health Requirements -Text Only-
5/22/2017

DIXON UNIFIED SCHOOL DISTRICT

Silveyville Primary

Anderson Elementary

Tremont Elementary

CA Jacobs Intermediate

Dixon High School

Maine Prairie

Gretchen Higgins

355 North Almond

415 East C Street

355 Pheasant Run

200 North Lincoln

455 East A Street

305 East C Street

1525 Pembroke

Dixon CA 95620

Dixon CA 95620

Dixon CA 95620

Dixon CA 95620

Dixon CA 95620

Dixon CA 95620

Dixon CA 95620

Phone:707-678-5573

Phone:707-678-5508

Phone:707-678-9533

Phone:707-678-9222

Phone: 707-678-2391

Phone: 707-678-4560

Phone: 707-678-6271

FAX 707-678-1402

FAX 707-678-2073

FAX 707-678-0298

FAX 707-678-1245

FAX 707-678-9318

FAX 707-678-4892

Fax: 707-693-1960


HEALTH REQUIREMENTS FOR SCHOOL

IMMUNIZATIONS: Students must present written verification of the following immunizations. The verification must include at least the month and year and be signed by the doctor or clinic:

  1. Polio - 4 doses, but 3 doses are enough if at least one was given after the 4th birthday.

  2. Diptheria, Pertussis, Tetanus (DTP/DTaP/DT) - 5 doses, except that 4 doses are enough if at least one was

given after the 4th birthday.

  1. Measles, Mumps, Rubella (MMR) - 2 doses given after the age of 1 year.

  2. Hepatitis B - at least 3 doses

  3. Varicella (Chicken Pox) - 1 dose or written verification from your physician that your child has had the

disease. 2 doses are required for students 13 and older.

  1. TB(PPD)Tuberculosis Skin Test — required for entering indergarten students within one year of entering kindergarten and for students coming from outside of the United States.

NOTE: Your child will not be able to attend school, if he/she is due for any of the required immunizations.

PHYSICAL EXAMINATION

The attached Report of Health Check-up for School Entry must be completed by your physician or clinic before your child enters 1st grade. The school nurses recommend that you schedule your child for a health check at the same time he/she receives the immunizations required for school, thus fulfilling both requirements at the same time.

The completed certificate can be returned to the school office before it closes in June or at the opening of the next semester. If you prefer, you can mail it to the school nurse at your child' s school.

The required physical examinations are free for children on Medi-Cal and for children from low or moderate income families. You can get the free health check-up from the Solano County Health Department (707-435­2010); Dixon Family Practice (707-635-1600); or Sutter West Medical Group (707-678-1623).

If you have any questions about the above requirements, feel free to contact the school nurse at Silveyville (678­5573); at Tremont (678-9533); at Gretchen Higgins (678-6271) or at Pupil Services (678-4346).

 

Name: Birth date:

Parent Signature:

 

Phone #:

 

 

 

 

 


To be completed by school staff only

Before the first day of school your child will need to receive the immunizations checked below:

 



Polio

MMR

Varicella

#1

#1

#1

#2

#2

#2

#3

 

DTP/DTaP/DT #1 #2 #3 #4 #5


 

Hepatitis B #1 #2 #3

TB Skin Test Date Done Date Read ______________

 

CADOCUMENTS AND SETTINGS \NLAVALLE DIXONUSD1DESKTOP \KINDERGARTEN REGISTRATION FORMSIHEALTH REQUIREMENTS FOR SCHOOL DOC