SAMPLE

XYZ Charter

719 Fourth Street

Anytown, TX

555-555-1234

 

State Immunization Requirements

 

MEMORANDUM

 

SUBJECT: Immunizations and shot record

 

TO: The Parents of__________________________________________________________

 

FROM: ____________________________________________________________________

 

DATE:_____________________________________________________________________

 

 

Our annual audit of immunization records has been completed and we need your help in updating our files.  Checked below are the shots or information required for your child.  If a vaccination is necessary, please take care of this right away.  If our records are in error, please provide us with an up-to-date copy of your child’s vaccinations.  Just a reminder that state law mandates every student have certain immunizations before attending school.  Children without proper immunizations after _____________will not be permitted in the classroom.

 

If a student receives an inoculation please bring a copy of the record to the school so it can be placed on file.  All shot records must show the day, month, and year they were given.

 

Thank you for your cooperation.  If you have specific questions about your child and his/her immunizations you may contact ___________________________________at 555-555-1234.

 

 

                                      

 

DTP - One dose required after 4th birthday

 

POLIO - One dose required after 4th birthday

 

MMR - Need 2nd MMR on entering kindergarten

 

MMR - Need 2nd MMR at 12 years of age

 

Hepatitis B - Need to start or complete series

 

Shot Record Needed

 

 

Director needs to update immunization records and requirements annually.

 

 

 

 

 

II. 36