This section applies to Daycare, Preschool, School Age and College State Laws.
Alabama
Daycare & Preschool Vaccine Mandates:
Attendees of day care and Head Start must be age-appropriately vaccinated against
diphtheria, tetanus, pertussis, measles, mumps, rubella, Haemophilus influenzae type b, polio, and chickenpox. (See school age)
4. Children’s Records
(3) Immunizations
(a) On the child’s first day of attendance, each child from two (2) months of age to lawful school age and each child of lawful school age who is not enrolled in public or private school kindergarten shall have a valid State of Alabama Certificate of Immunization (ADPH-F-IMM-50), on file in the center, unless one of the following is on file in the center:
A valid State of Alabama Certificate of Medical Exemption (ADPH-F-IMM-50);
OR
A valid Alabama Certificate of Religious Exemption
(ADPH-F-IMM-52).
(b) Each child’s Certificate of Immunization shall be updated according
to the expiration date indicated on the certificate.
School-age Vaccine Mandates:
Authority: Code of Alabama, 1975, Section 16-30-5, et. seq.
420-6-1-.03 Immunization Schedule.
(1) Except as provided in Section 420-6-1-.02 and in the Code of Alabama, 1975, Section 16-30-5, each pupil, prior to entering Alabama school grade kindergarten through twelfth grade shall receive age-appropriate immunizations as below:
(a) at a minimum, four (4) doses of diphtheria, tetanus and pertussis vaccination. The last dose must be administered after the child’s fourth birthday. Booster doses of tetanus-diphtheria toxoid vaccine must be given 5-10 years after the preschool booster.
(b) 4 doses of polio vaccine, separated by at least 28 days. Only 3 doses are needed if the 3rd dose was administered after the 4th birthday.
(c) immunization against mumps and rubella. This dose shall be administered at 12 months of age or later.
(d) two (2) doses of measles-containing vaccine. The first dose shall be administered at 12 months of age or later and the second dose shall be administered at least 28 days later.
(e) varicella vaccine subject to the following schedule unless there is documentation of a positive varicella titer or a date of varicella disease. This requirement is effective for students entering kindergarten beginning fall of 2001 and will escalate by one successive grade each year for the following 12 years to include all grades, kindergarten through twelfth, beginning fall of 2013:
(i) one dose of varicella vaccine at 12 months of age or older for persons less than 13 years of age;
(ii) two doses of varicella vaccine separated by at least 28 days for persons 13 years of age or older beginning the vaccination series.
(2) Vaccine doses administered <4 days before the minimum interval or age should be counted as valid. Doses administered >5 days earlier than the minimum interval or age should not be counted as valid doses and should be repeated as age-appropriate.
Medical and Religious Exemption
The State of Alabama does not recognize philosophical, moral, or ethical exemption from vaccination. A medical exemption may be issued by a physician or an Alabama certificate of Religious Exemption may be obtained from the local county health department.
Authority: Code of Alabama, 1975, Section 16-30-5, et. seq.
(3) A written objection from the parent or guardian of a student based on religious tenets and practices shall be submitted in person by the parent or guardian to the County Health Department for issuance of a Certificate of Religious Exemption from the required immunizations or testing. A licensed physician can provide individual exemption from the required immunizations or testing on a Certificate of Medical Exemption. The Certificate of Religious Exemption and the Certificate of Medical Exemption will be on forms approved by the Alabama Department of Public Health and will be accepted in lieu of the Certificate of Immunization.
Alabama Admin. Code r. 420-6-1-.02 General Provisions.
(1) The board of education and the governing authority of each private school shall require each pupil, prior to entering kindergarten or first grade or prior to re-entering the higher grades of the schools of Alabama, to present a certificate of immunization for the prevention of diphtheria, tetanus, pertussis, poliomyelitis, measles, rubella and mumps (Code of Ala. 1975, § 16-30-4). Pupils who have passed their seventh birthday are exempt from a requirement for pertussis immunization.
(2) Such certificate shall be on the form approved by the Alabama Department of Public Health and shall be made a part of the pupil’s school record. When a student leaves a school upon graduation, transfer, relocation or otherwise; the school may return the original certificate to the student’s parents/guardians and retain a legible copy in the school record.
(3) A written objection from the parent or guardian of a student based on religious tenets and practices shall be submitted in person by the parent or guardian to the County Health Department for issuance of a Certificate of Religious Exemption from the required immunizations or testing. A licensed physician can provide individual exemption from the required immunizations or testing on a Certificate of Medical Exemption. The Certificate of Religious Exemption and the Certificate of Medical Exemption will be on forms approved by the Alabama Department of Public Health and will be accepted in lieu of the Certificate of Immunization.
College Requirements
College vaccination requirements are specified by individual institutions. There are no
state-regulated college requirements for vaccination. However, it is recommended that college attendees be up-to-date with all childhood vaccines and to consider Meningococcal vaccination for college freshman who will be living in dormitories.
Alaska
Vaccine Mandates:
REGULATIONS 4 AAC 06.055 IMMUNIZATIONS REQUIRED.
(a) Before entry in a state public school district or nonpublic school offering pre-elementary education through the 12th grade, or any combination of these grades, a child shall be immunized against
(1) diphtheria, tetanus, polio, pertussis, measles and rubella, except that pertussis is not required in children over six and rubella is not required in children 12 years or older; and
(2) beginning July 1, 2001, mumps, hepatitis A, and hepatitis B.
(b) This section does not apply if the child
(1) has a valid immunization certificate consisting of
(A) a statement by a physician listing the date that each required immunization was given; or
(B) a copy of a clinic or health center record listing the date that each required immunization was
given;
(2) has a statement signed by a doctor of medicine (M.D.), doctor of osteopathy (D.O.), physician assistant, or advanced nurse practitioner licensed to practice in this state, stating that immunizations would, in that individual’s professional opinion, be injurious to the health of the child or members of the child’s family or household; or
(3) has an affidavit signed by his parent or guardian affirming that immunization conflicts with the tenets and practices of the church or religious denomination of which the applicant is a member.
(c) A student registering in a school in a community where regular medical services are not available on at least a weekly basis and who does not have the required immunizations, may be provisionally admitted to a pre-elementary, elementary or secondary program for a reasonable period of time for the prevailing circumstances but not exceeding 90 days after enrollment. No children will be provisionally admitted except in exceptional circumstances. Where exceptions are granted, they shall be reported
to and discussed with the communicable disease section of the division of public health, Department of Health and Social Services, who will then be responsible for determining that the required immunizations are completed during the provisional period.
Daycare Vaccine Mandates:
REGULATIONS AAC 60.100 PHYSICAL EXAMINATION FOR CHILDREN
[for children in a Pre-Elementary (Early Childhood) School]
(a) (deals with tuberculosis skin testing)
(b) Before first entering school, a child must have received the immunizations required under 4 AAC 62.450(b) or provide evidence of exemption described in 4 AAC 62.450(c).
4 AAC 62.450 HEALTH IN CHILD CARE FACILITIES.
(a) At or before admission of a child, a childcare facility shall obtain from the child’s parent
(1) a valid immunization certificate; or
(2) evidence that the child is exempt from immunization.
(b) A valid immunization certificate is a copy of the child’s original immunization record showing that, in a manner consistent with the timetable prescribed by the Department of Health and Social Services childhood immunization schedule, the child has received, or has begun and is continuing to receive, immunizations for the child’s age against
(1) diphtheria, tetanus, polio, measles, and rubella;
(2) if the child is less than seven years of age, pertussis; and
(3) beginning July 1, 2001, mumps, hepatitis A, hepatitis B, chickenpox, and Haemophilus influenzae type b. The 2000 version of the Department of Health and Social Services childhood immunization schedule is adopted by reference. The immunization record is limited to either or both a statement by a physician, listing the date that each required immunization was given, or a clinic or health center record listing the date that each required immunization was given.
(c) Evidence of exemption from immunization must include one of the following:
(1) A statement signed by a doctor of medicine (M.D.), doctor of osteopathy (D.O.), physician assistant, or advanced nurse practitioner licensed in this state, stating that immunizations would, in that individual’s professional opinion, be injurious to the health of the child or members of the child’s family or household;
(2) an affidavit signed by the child’s parent or guardian, affirming that immunization conflicts with the tenets and practices of the church or religious denomination of which the parent or guardian is a member; or
(3) entry for a one day exemption that the child is attending the childcare facility for the first time.
(d) A childcare facility in a community where regular medical services are not available on at least a weekly basis may provisionally admit a child who does not have the immunization certificate required under (a) of this section until the certificate can be obtained, but for no longer than 60 days.
(e) A satisfactory immunization audit report from the Department of Health and Social Services division of public health during the previous licensure period will be accepted as evidence that the childcare facility satisfied the requirements of (a) – (d) of this section.
REGULATIONS 7 AAC 50.455 HEALTH IN FULL TIME CARE FACILITIES.
(a) A full time care facility shall either obtain evidence of immunization as specified in this section for each child in care or initiate immunizations as specified in this section no later than 30 days after the child is in care. A full time care facility shall ensure that each child in care has or is given, in a manner consistent with the timetable prescribed by the department’s childhood immunization schedule, immunizations appropriate to the child’s age against
(1) diphtheria, tetanus, polio, measles, and rubella;
(2) if the child is less than seven years of age, pertussis; and
(3) beginning July 1, 2001, mumps, hepatitis A, hepatitis B, chickenpox, and Haemophilus influenzae type b. If a child has not received all immunizations as provided in the schedule, the facility shall initiate completion of immunizations as rapidly as is medically indicated.
(b) A full time care facility shall obtain health information on each child under care when the child is accepted for care, to the extent possible. In addition to the information required to be obtained by 7 AAC 50.300(a), health information to be obtained by the facility must include
(1) the date of the child’s last physical examination and the name of the medical provider who conducted it;
(2) a report of any health problems of the child; and
(3) the child’s immunization history.
(c) If a child over three years of age has not been under regular medical supervision or has not had a health examination by a licensed physician, physician’s assistant, or public health nurse within one year before the child’s admission to the full time care facility, a full time care facility shall arrange for an examination to be completed within 30 days in accordance with the early periodic screening, diagnosis, and treatment (EPSDT) schedule set out in 7AAC 43.452 and shall provide continuing medical and dental services according to that schedule. A full time care facility shall arrange for the examination of a child three years of age or younger within 30 days of receiving the child for care, unless the child has had a health examination within three months of admission, and shall provide continuing care according to the EPSDT schedule.
Daycare and School Age Vaccine Mandates
Daycare Mandates:
Medical Proof of Natural Immunity:
FOR VARICELLA (“chickenpox”) ONLY:
If a parent reports that his/her child has already had chickenpox, varicella vaccine is not needed. A parental report of chickenpox should be documented in the facility record and the child’s medical record. Children in a child care facility who have never been vaccinated against chickenpox or never had the disease will need the immunization.
DISEASES OTHER THAN VARICELLA: A child must have either the required immunizations or must have laboratory-confirmed (usually this requires a blood test) immunity against a specific disease.
PROCEDURE FOR CLAIMING LABORATORY-CONFIRMED IMMUNITY:
(1) The child must receive appropriate laboratory testing (i.e., antibody levels indicating immunity to the specific disease) verified by an Alaska-licensed medical doctor (MD), doctor of osteopathy (DO), advanced nurse practitioner (ANP), or physician assistant (PA). (Note: The State of Alaska does not provide free antibody testing except in the circumstances of an ongoing outbreak.)
(2) An Alaska-licensed MD, DO, ANP, or PA must evaluate the laboratory result to determine if it indicates immunity. If the medical professional determines the result shows immunity to a disease, he/she should give the following to the child’s parent/guardian:
l A copy of the laboratory report and
l A cover note stating the child does not need additional doses of the specified vaccine because the child is already immune to the disease in question.
(3) The parent must submit both the laboratory report and the cover note to the child’s school or child care facility to meet the immunization requirement.
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All children admitted to child care facilities are required to have an immunization record upon entry. The only potential exceptions to this requirement are:
1) For those child care facilities that provide drop-in care, children are allowed to be placed in the facility for one visit only. The parent or guardian must provide the child care facility with an appropriate immunization record on the second visit.
2) If a child registers for child care entry in a community where regular medical services are not available on at least a weekly basis, he/she may be provisionally admitted for a reasonable time for the prevailing circumstances, but not exceeding 60 days after enrollment (4 AAC 62.450). Any such provisional exceptions must be reported by the child care facility to the Alaska Immunization Program at 269-8000.
Can a child be admitted to a school provisionally, while waiting on an immunization record?
All children admitted to school are required to have an immunization record upon entry.
The only exception in which provisional admittance may be allowed is if a child registers for school in a community where regular medical services are not available on at least a weekly basis. He/she may be provisionally admitted for a reasonable time for the prevailing circumstances, but not exceeding 90 days after enrollment (4 AAC 06.055). Any such provisional exceptions must be reported by the school to the Alaska Immunization Program at 269-8000
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…all children transferring from one Alaska school to another or from schools outside
Alaska to an Alaska school are required to provide the new school with a date and dose specific, medicallyverified immunization record. (Note: School district immunization records signed by a school nurse are considered medically verified records. School district immunization records that are not verified by a clinic/health care provider are not “medically verified” and additional records will be needed.)
Medical and Religious Exemption-
Daycare & School Age Exemption:
Alaska’s School and Child Care Immunization Regulations (pp. 27-30) allow limited exemptions to the immunization requirements, when submitted with the following designated information:
a) Medical – a statement signed by a Medical Doctor (MD), Doctor of Osteopathy (DO), Advanced Nurse Practitioner (ANP) or Physician Assistant (PA) licensed to practice in Alaska affirming that in his/her professional opinion immunization would be injurious to the health of the child or members of his family or household. The state regulations that deal with medical exemptions are 4 AAC 06.055 (b)(3) and 4 AAC 62.450 (c) (2). See pp. 27-30.
b) Religious – an affidavit signed by the child’s parent or guardian affirming that immunization conflicts with the tenets and practices of the church or religious denomination of which the applicant is a member.
*NOTE: Personal or philosophical exemptions are NOT accepted.
Sample medical and religious exemption forms may be found on p. 37 (medical) and p. 38 (religious). Although the form itself is not required for either type of exemption, a religious exemption request must contain the exact wording as detailed in the immunization regulations.
All religious exemptions must be documented on the “Religious Exemption Form” (sample, p. 38) or contain the exact exemption wording found in 4 AAC 06.055 (b)(3)or 4 AAC 62.450(c)(2). The parent or guardian must sign the statement which states “I/We affirm that immunization conflicts with the tenets and practices of the church or religious denomination of which the applicant is a member.” A parent who signs such a statement based upon philosophical opposition to immunization is in violation of Alaska law.
Alaska Immunization regulations 4 AAC 06.055 (b)(3) and 4 AAC 62.450 (c)(2) state that immunization requirements do not apply if the child has “an affidavit signed by his parent or guardian affirming that immunizations conflict with the tenets or practices of the church or religious denomination of which the applicant is a member.”
The state-recommended Religious Exemption Form (p. 38) provides the format for acknowledgment of the affidavit by a Notary Public. During routine on-site assessments, Alaska Immunization Program staff will collect information about whether religious exemptions are notarized, but they will not classify exemptions that lack a notary’s signature as being “out of compliance.” Schools and child care facilities should develop their own policies about whether they will accept religious exemptions that have not been signed by a notary public.
A list should be kept of all exempt children, including those children in a waiting period. In the event of an outbreak, these children must be quickly identified and encouraged to receive appropriate vaccinations or be excluded.
Medical and Religious Exemption Form
* Note-You simply quote the existing law in your letter or use the form above and you do not need to reveal any affiliations or your religious denomination.
Arizona
Vaccine Mandates:
See Also: 2008-2009 School Immunization Requirements
Vaccine Exemptions are Medical, Religious, and Philosophical
*Selective vaccine exemptions are allowable.
TITLE 36. PUBLIC HEALTH AND SAFETY CHAPTER 7.1. CHILD CARE PROGRAMS
ARTICLE 1. DAY CARE CENTERS
A.R.S. § 36-883 (2006)
§ 36-883. Standards of care; rules; classifications
C. Any rule that relates to educational activities, physical examination, medical treatment or immunization shall include appropriate exemptions for children whose parents object on the ground that it conflicts with the tenets and practices of a recognized church or religious denomination of which the parent or child is an adherent or member.
TITLE 15. EDUCATION CHAPTER 8. SCHOOL ATTENDANCE
ARTICLE 6. SCHOOL IMMUNIZATION
A.R.S. § 15-872 (2006)
§ 15-872. Proof of immunization; noncompliance; notice to parents; civil immunity
A. The director of the department of health services, in consultation with the superintendent of public instruction, shall develop by rule standards for documentary proof.
B. A pupil shall not be allowed to attend school without submitting documentary proof to the school administrator unless the pupil is exempted from immunization pursuant to section 15-873.
C. Each public school shall make full disclosure of the requirements and exemptions as prescribed in sections 15-872 and 15-873.
D. On enrollment, the school administrator shall suspend that pupil if the administrator does not have documentary proof and the pupil is not exempted from immunization pursuant to section 15-873.
E. Notwithstanding subsections B and D of this section, a pupil may be admitted to or allowed to attend a school if the pupil has received at least one dose of each of the required immunizations prescribed pursuant to section 36-672 and has established a schedule for the completion of required immunizations. The parent, guardian or person in loco parentis of a pupil shall present to the school administrator documentary proof of the immunizations received and a schedule prepared by the pupil’s physician or a health agency for completion of additional required immunizations.
F. The school administrator shall review the school immunization record for each pupil admitted or allowed to continue attendance pursuant to subsection E of this section at least twice each school year until the pupil receives all of the required immunizations and shall suspend a pupil as prescribed in subsection G of this section who fails to comply with the immunization schedule. Immunizations received by a pupil shall be entered in the pupil’s school immunization record.
G. Unless proof of an exemption from immunization pursuant to section 15-873 is provided, a pupil who is admitted or allowed to continue to attend and who fails to comply with the immunization schedule within the time intervals specified by the schedule shall be suspended from school attendance until documentary proof of the administration of another dose of each appropriate immunizing agent is provided to the school administrator.
H. The provisions of subsections B, D and E of this section do not apply to homeless pupils until the fifth calendar day after enrollment.
I. A school and its employees are immune from civil liability for decisions concerning the admission, readmission and suspension of a pupil which are based on a good faith implementation of the requirements of this article.
A.R.S. § 15-873 (2006)
§ 15-873. Exemptions; nonattendance during outbreak
A. Documentary proof is not required for a pupil to be admitted to school if one of the following occurs:
1. The parent or guardian of the pupil submits a signed statement to the school administrator stating that the parent or guardian has received information about immunizations provided by the department of health services, understands the risks and benefits of immunizations and the potential risks of non-immunization and that due to personal beliefs, the parent or guardian does not consent to the immunization of the pupil.
2. The school administrator receives written certification which is signed by the parent or guardian and by a physician, which states that one or more of the required immunizations may be detrimental to the pupil’s health and which indicates the specific nature and probable duration of the medical condition or circumstance which precludes immunization.
B. An exemption pursuant to subsection A, paragraph 2 is only valid during the duration of the circumstance or condition which precludes immunization.
C. Pupils who lack documentary proof of immunization shall not attend school during outbreak periods of communicable immunization-preventable diseases as determined by the department of health services or local health department. The department of health services or local health department shall transmit notice of this determination to the school administrator responsible for the exclusion of the pupils.
ARIZONA ADMINISTRATIVE CODE TITLE 9. HEALTH SERVICES
CHAPTER 6. DEPARTMENT OF HEALTH SERVICES: COMMUNICABLE DISEASES
ARTICLE 7. VACCINE-PREVENTABLE DISEASES
A.A.C. § R9-6-706 (2006)
R9-6-706. Exemptions to Immunizations
A. A child who has reached a fifth birthday is exempt from the Hib immunization requirement.
B. A child who has reached a seventh birthday is exempt from the pertussis immunization requirement.
C. A child:
1. Until September 1, 2011, is exempt from the VAR immunization requirement
if the child’s responsible person states, verbally or in writing, that the child has had varicella; and
2. After September 1, 2011, is not exempt from the VAR immunization requirement unless the child provides laboratory evidence of immunity to varicella.
D. A child who submits laboratory evidence of immunity to a disease to a school or child care is not required to be immunized against that disease as a condition for school or child care entry.
E. For a child attending a school, a parent or guardian shall submit to the school a written statement of exemption from immunization for personal beliefs as required in A.R.S. § 15-873(A)(1) or written certification of medical exemption as required in A.R.S. § 15-87 (A)(2) on a form provided by the Department that contains:
1. The child’s name;
2. The child’s date of birth;
3. The type of exemption requested;
4. The immunizations from which the parent or guardian is requesting an exemption;
5. Whether the medical exemption is permanent or temporary, if applicable;
6. The date the medical exemption terminates, if applicable;
7. The parent or guardian’s signature and the date signed; and
8. The physician’s signature and the date signed, if applicable.
F. For a child attending a child care, a responsible person shall submit to the child care a written statement of exemption from immunization on a form provided by the Department that includes:
1. The child’s name,
2. The child’s date of birth,
3. The type of exemption,
4. The immunizations from which the responsible person is requesting an exemption,
5. If a medical exemption, whether the medical exemption is permanent or temporary,
6. If temporary, the date the medical exemption terminates, if applicable,
7. The responsible person’s signature and the date signed, and
8. The physician’s signature and the date signed, if applicable.
G. A child care administrator or school administrator shall:
1. Record an exemption on a child’s immunization record,
2. Allow a child with a temporary medical exemption to attend a child care or school until the date the temporary exemption terminates, and
3. Notify a child’s responsible person in writing of the date the child is required to complete all immunizations before the temporary medical exemption terminates.
Arkansas
Vaccine Mandates:
Daycare Requirements:
School Age Requirements:
Promulgated Under the Authority of Ark. Code Ann. §§ 20-7-109, 6-18-702, 6-60-504, and 20-78-206.
Kindergarten Through Grade Twelve.
1. Except as otherwise provided in these regulations, no child shall be admitted to a public or private school of this state who has not been immunized against poliomyelitis, diphtheria, tetanus, pertussis, red (rubeola) measles, rubella, mumps, hepatitis B, and varicella (See Table II.), as evidenced by a certificate of a licensed physician or a public health department acknowledging the immunization.
2. The requirements for entry into school are:
Kindergarten: At least four doses of Diphtheria/Tetanus/ Acellular Pertussis (DTaP), Diphtheria/Tetanus/Pertussis (DTP), Diphtheria/Tetanus (DT pediatric), at least three doses of Polio vaccine; two doses of Rubeola (measles) vaccine, one dose of Rubella (German measles) vaccine, one dose of Mumps vaccine, three doses of Hepatitis B vaccine and one dose of Varicella (chickenpox) vaccine. 1st through 12th grade: At least three doses of Diphtheria/Tetanus/ Acellular Pertussis (DTaP), Diphtheria/Tetanus/Pertussis (DTP), Diphtheria/Tetanus (DT pediatric), or Tetanus/Diphtheria (Td Adult), at least three doses of polio vaccine; two doses of Rubeola (measles) vaccine, one dose of Rubella (German measles) vaccine, one dose of Mumps vaccine.
Transfer students : (Students not in your school district last year): At least three doses of Diphtheria/Tetanus/ Acellular Pertussis (DTaP), Diphtheria/Tetanus/Pertussis (DTP), Diphtheria/Tetanus (DT pediatric), or Tetanus/Diphtheria (Td Adult), at least three doses of polio vaccine; two doses of Rubeola (measles) vaccine, one dose of Rubella (German measles) vaccine, one dose of Mumps vaccine, and an appropriate series of Hepatitis B vaccine. (See Table II)
7th grade: In addition to the vaccines requirements listed under 1st through 12th grade, one or two doses of varicella and an appropriate series of Hepatitis B vaccine. (See Table II)
An appropriate series of Hepatitis B is required for Transfer students (students not in your school district last school year) and students entering the seventh grade. (See Table II.)
3. A facility may temporarily admit a child provided that the child becomes appropriately immunized, is in-process of receiving the needed doses of vaccine, or shows proof that they have applied for an exemption for those vaccines he/she has not received within thirty (30) program days after the child’s original admission.
C. Colleges and Universities.
1. No part-time student housed in on-campus premises and no full-time student may attend a public or private college or university in this state unless he or she has furnished proof, within such time as set by the college or university, but not to exceed thirty (30) calendar days after enrollment, by way of an official record from another educational institution in Arkansas or a certificate from a licensed medical doctor or an authorized public health department representative, that he or she has immunity against measles and rubella. Immunity can be shown by providing a serological test confirming immunity or having received two doses of measles and one dose of rubella for incoming freshmen and foreign students and one dose of measles and one dose of rubella for all other students.
Exemptions: Medical, Religious, Philosophical
SECTION IV. EXEMPTIONS.
A. General Requirements.
1. With the exception of medical exemptions for college and university students, exemptions shall be granted only by the Department of Health.
2. Individuals shall complete an annual application for medical, religious, and philosophical exemptions.
3. A notarized statement by the individual requesting the exemption must accompany the application.
4. All individuals requesting an exemption must complete an educational component developed by the Department of Health that includes information on the risks and benefits of vaccinations.
5. All individuals must sign an “informed consent” form provided by the Department of Health that includes:
a) A statement of refusal to vaccinate;
b) A statement of understanding that at the discretion of the Department of Health the non-immunized child or individual may be removed from the applicable facility during an outbreak if the child or individual is not fully vaccinated; and
c) A statement of understanding that the child or individual shall not return to the applicable facility until the outbreak has been resolved and the Department of Health approves the return.
B. Medical Exemptions.
1. Only a letter issued by the MEDICAL DIRECTOR, COMMUNICABLE DISEASE/IMMUNIZATION WORK UNIT, stating the vaccine or vaccines for which a child is exempt is to be accepted as a valid medical exemption by the school or childcare facility. Statements from private physicians are not to be accepted by the school or childcare facility without this letter.
2. Any individual, who has had a vaccine-preventable disease, as documented by an appropriate diagnostic or blood serology test, should not be required to have the vaccine for that disease. An individual, who is uncertain of their disease history, has lost his/her immunization records or whose serology test results are unavailable should be properly immunized for those diseases.
3. If a medical doctor licensed to practice in Arkansas determines that an individual is deemed to have a physical disability which may contraindicate one (1) or more of the required vaccinations, a certificate approved by the Department of Health and signed by the medical doctor may be accepted by a college or university in lieu of proof of vaccination.
C. Religious Exemptions.
1. In addition to the general requirements found in section IV (A), the Arkansas Department of Health’s standard form for religious exemptions must be submitted to the CD/Immunization Work Unit. This form is available from the Arkansas Department of Health upon request. A notarized statement is required from the parents or legal guardians that immunization conflicts with their religious beliefs.
D. Philosophical Exemptions.
1. In addition to the general requirements found in section IV (A), the Arkansas Department of Health’s standard form for philosophical exemptions must be submitted to the Division of CD/Immunization. This form is available from the Arkansas Department of Health upon request. A notarized statement is required from the parents or legal guardians that immunizations conflict with their philosophical beliefs.
SECTION V. EXCLUSION FROM FACILITIES.
A. Childcare and Childhood Education Facilities
1. Children will not be allowed to attend a childcare facility unless they can document appropriate immunizations, are in the process of completing the minimum requirements, or have a medical, religious, or philosophical exemption for those vaccines he/she has not received. “In process” means they have received at least one dose of the required immunizations and are waiting the minimum time interval to receive the additional doses. When a student is admitted who is in the process of completing the required minimum immunizations, it is the responsibility of the childcare facility to assure the child completes the required doses on schedule. A written statement from a public health nurse or private physician stating that the child is in process and containing a date when he/she must return for the next immunization should be in the child’s file. If a child does not produce documentation of additional immunization per the schedule or show proof that they have applied for an exemption from the immunization requirements, they must be excluded from the childcare facility until documentation is provided.
The immunization series does not need to be restarted as each dose of vaccine counts toward the minimum requirement.
B. Kindergarten through Grade Twelve
1. The responsibility for the enforcement of these regulations rests equally with each school district of this state and the parent or guardian of the student and each of them shall be separately and individually liable for permitting any violation of this law. Students will not be allowed to attend school unless they can document appropriate immunizations, are in the process of completing the minimum requirements or have a medical, religious, or philosophical exemption for those vaccines he/she has not received “In process” means they have received at least one dose of the required immunizations and are waiting the minimum time interval to receive the additional doses. When a student is admitted who is in the process of completing the required minimum immunizations, it is the responsibility of the school to assure the student completes the required doses on schedule. A written statement from a public health nurse or private physician stating that the child is in process and containing a date when he/she must return for the next immunization should be in the student’s file. If a student does not produce documentation of additional immunizations per the schedule or show proof that they have applied for an exemption from the immunization requirements, they must be excluded from school until documentation is provided. When students are in violation of the compulsory school attendance law, the local enforcing authority shall be notified.
California
School Age Vaccine Mandates:
About the New 4-Day Grace Period
A 2002 national recommendation from the U.S. Advisory Committee on Immunization Practices (ACIP) permits a 4-day grace period on minimum ages and intervals. School law requirements now reflect this grace period. Students who have received vaccine doses up to (and including) 4 days before the recommended minimum ages or required intervals will not have to repeat those doses. This means, for example, that a child who received MMR up to and including four days prior to his or her first birthday meets the requirement.
Documented History of Chickenpox
If a child already has had chickenpox, the health care provider will indicate it on the child’s Immunization Record with a note or stamp. Providers will consider clinical diagnosis, laboratory tests, and/ or parental history, in deciding if there is sufficient evidence of past chickenpox disease.
Allow 30 days for a cumulative folder from another school to reach your school…
Also see: California Department of Public Heath
Exemptions: Medical, Religious, Personal Beliefs
Personal Beliefs:
California law states that “Immunization of a person shall not be required for admission…if the parent or guardian…files…a letter or affidavit stating that the immunization is contrary to his or her beliefs.” Any parent has the option to take the personal beliefs exemption at any time. The parent affidavit for an exemption is on the back of the child’s Blue Card; it must be signed by the parent or guardian and kept in the student’s official record. If the child has had some immunizations, record those
dates as usual, if available.
Although California’s law does not require parents/guardians taking the personal
beliefs exemption (PBE) to state the reason(s) for their belief or the specific vaccines
involved in their belief, the clear intent of the law is that the PBE option be used for deeply held personal beliefs, not for convenience, such as a parent misplacing an immunization record.
Medical Exemptions:
A temporary or permanent medical exemption to one or more of the immunizations
may be granted under certain circumstances with a signed note from a physician. This is also discussed in the Exemptions Information Sheet (page C-61). The note from the physician should be stapled to the student’s Blue Card. Temporary medical exemptions must be followed up with an extension of the
deadline date or receipt of the needed vaccine doses when the temporary medical exemption expires.
Cal Health & Saf Code § 120365 (2006)
§ 120365. Letter or affidavit stating beliefs opposed to immunization; Temporary exclusion from school
Immunization of a person shall not be required for admission to a school or other institution listed in Section 120335 if the parent or guardian or adult who has assumed responsibility for his or her care and custody in the case of a minor, or the person seeking admission if an emancipated minor, files with the governing authority a letter or affidavit stating that the immunization is contrary to his or her beliefs. However, whenever there is good cause to believe that the person has been exposed to one of the communicable diseases listed in subdivision (a) of Section 120325, that person may be temporarily excluded from the school or institution until the local health officer is satisfied that the person is no longer at risk of developing the disease.
Cal Health & Saf Code § 120370 (2006)
§ 120370. Statement by physicians contraindicating immunization
If the parent or guardian files with the governing authority a written statement by a licensed physician to the effect that the physical condition of the child is such, or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances that contraindicate immunization, that person shall be exempt from the requirements of Chapter 1 (commencing with Section 120325, but excluding Section 120380) and Sections 120400, 120405, 120410, and 120415 to the extent indicated by the physician’s statement.
17 CCR 6051 (2006)
§ 6051. Unconditional Admission with Permanent Medical Exemption or Personal Beliefs Exemption
A pupil with a permanent medical exemption or a personal beliefs exemption to immunization shall be admitted unconditionally. A permanent medical exemption shall be granted upon the filing with the governing authority of a written statement from a licensed physician to the effect that the physical condition of the pupil or medical circumstances relating to the pupil are such that immunization is permanently not indicated. The fact of the permanent medical exemption shall be recorded on the California School Immunization Record, PM 286 (1/02) as provided in Section 6070. A permanent medical exemption may be provided for one or more vaccines. A physician may provide a written statement that the pupil is medically exempt from the measles (rubeola) and/or varicella (chickenpox) requirements as a result of having had measles (rubeola) and/or varicella (chickenpox) disease, respectively. A physician may provide a written statement that the pupil is medically exempt from the rubella and/or mumps requirement as a result of having had laboratory confirmed illness with the corresponding disease. A personal beliefs exemption shall be granted upon the filing with the governing authority of a letter or affidavit from the pupil’s parent or guardian or adult who has assumed responsibility for his or her care and custody in the case of a minor, or the person seeking admission if an emancipated minor, that such immunization is contrary to his or her beliefs. The fact of the personal beliefs exemption shall be recorded on the California School Immunization Record, PM 286 (1/02). A pupil with an exemption which is not based on pre-existing immunity to disease may be subject to exclusion pursuant to Section 6060.
§ 6051. Pupil Not Completely Immunized and Exposed to Communicable Disease.
Whenever the governing authority has good cause to believe that a pupil who is not completely immunized against a particular communicable disease may have been exposed to that disease, that information shall be reported by the governing authority immediately by telephone to the local health officer. The local health officer shall determine whether the pupil is at risk of developing the disease and, if so, may require the exclusion of the pupil from that school, child care center, day nursery, nursery school, family day care home, or development center until the completion of the incubation period and the period of communicability of the disease.
Colleges and Universities:
The California State University and University of California systems require three doses of hepatitis B vaccine for entrants aged 18 years (up to the 19th birthday) and younger. The three vaccine doses may have been received at any time during the student’s life. Note that students who received two doses of the special 2-dose vaccine formulation (see page 6) meet the college requirement provided both doses were received between ages 11 and 15 years (i.e., before the 16th birthday). Students who have not completed the series but are not currently due for a dose can be admitted on condition that they subsequently complete the series. Exemptions to the requirement are allowed for medical reasons or personal beliefs.
Colorado
Exemptions: Medical, Religious, Personal
Immunization and Exemption Form
College Immunization and Exemption Form
C.R.S. 25-4-903 (2006)
25-4-903. Exemptions from immunization
(1) (Deleted by amendment, L. 97, p. 409, § 2, effective July 1, 1997.)
(2) It is the responsibility of the parent or legal guardian to have his or her child immunized unless the child is exempted pursuant to this section. A student shall be exempted from receiving the required immunizations in the following manner:
(a) By submitting to the student’s school certification from a licensed physician that the physical condition of the student is such that one or more specified immunizations would endanger his or her life or health or is medically contraindicated due to other medical conditions; or
(b) By submitting to the student’s school a statement of exemption signed by one parent or guardian or the emancipated student or student eighteen years of age or older that the parent, guardian, or student is an adherent to a religious belief whose teachings are opposed to immunizations or that the parent or guardian or the emancipated student or student eighteen years of age or older has a personal belief that is opposed to immunizations.
(3) The state board of health may provide, by regulation, for further exemptions to immunization based upon sound medical practice.
(4) All information distributed to parents by school districts regarding immunization shall inform them of their rights under subsection (2) of this section.
C.R.S. 25-4-1704 (2006)
25-4-1704. Infant immunization program – delegation of authority to immunize minor
(1) There is hereby created in the department an infant immunization program which is established to immunize infants against vaccine preventable disease. Such program shall be implemented on and after January 1, 1993.
(2) Every parent, legal guardian, or person vested with legal custody or decision-making responsibility for the medical care of a minor, or person otherwise responsible for the care of an infant residing in this state, shall be responsible for having such infant vaccinated in compliance with the schedule of immunization established by the board of health; except that, failure to vaccinate a child in accordance with this subsection (2) shall not constitute sufficient grounds for any insurance company to deny a claim submitted on behalf of a child who develops a vaccine preventable disease.
(2.5)
(d) A person may not consent to the immunization of a minor pursuant to this subsection (2.5) if:
(I) The person has actual knowledge that the parent, legal guardian, person vested with legal custody of a minor or decision-making responsibility for the medical care of a minor, or other adult person responsible for the care of a minor in this state has expressly refused to give consent to the immunization; or
(II) The parent, legal guardian, person vested with legal custody of a minor or decision-making responsibility for the medical care of a minor, or other adult person responsible for the care of a minor in this state has told the person that the person may not consent to the immunization of the minor or, in the case of a written authorization, has withdrawn the authorization in writing.
(3) In addition to the immunization obligations set forth in section 25-4-905, relating to the immunization of indigent children, and except as provided in subsection (4) of this section, the department shall provide at public expense, subject to available appropriations, systematic immunizations to those infants that are not exempt from such immunization pursuant to paragraph (a) or (b) of subsection (4) of this section. The manner and frequency of vaccine administration shall conform to recognized standards of medical practice which are necessary for the protection of public health.
(4) An infant shall be exempted from receiving the required immunizations:
(a) Upon submitting certification from a licensed physician that the physical condition of the infant is such that one or more specified immunizations would endanger the infant’s life or health; or
(b) Upon submitting a statement signed by one parent or guardian that such parent or guardian adheres to a religious belief whose teachings are opposed to immunizations, or that such parent or guardian has a personal belief that is opposed to immunization.
Connecticut
Daycare and School Age Mandated Vaccines
Daycare Requirements Only:
19a-79-6a. Health and safety
(d) Immunization requirements
(1) A child seeking admission to or attending a child day care center or group day care home shall be protected as age-appropriate by adequate immunization against diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, rubella, hemophilus influenzae type b, hepatitis b if such child was born after December 31, 1993, and varicella if such child was born after December 31, 1996, and against any other disease for which vaccination is recommended in the current schedule for active immunization adopted by the Commissioner in accordance with Connecticut General Statutes Section 19a-7f.
(2) The provider shall admit no child to a child day care center or group day care home unless such child’s parent furnishes documentation of age-appropriate immunization, immunization-in-progress or exemption from immunization as specified in subdivision (3) of this subsection. No child shall be permitted to continue to attend a child day care center or group day care home for more than thirty (30) days unless such child continues to meet said requirements of subdivision (3) of this subsection.
(3) For each enrolled child, the operator shall obtain from the child’s parent and keep on file at the child day care center or group day care home one or more of the following types of documentation for each of the diseases listed in subdivision (1) of this subsection:
(A) a statement signed and dated by a physician, physician assistant, or an advanced practice registered nurse indicating that the child is current or in progress with immunizations according to the schedule adopted by the Commissioner in accordance with Connecticut General Statutes Section 19a-7f and that names the appointment date for the child’s next immunization;
(B) a statement signed and dated by a physician, physician assistant, or an advanced practice registered nurse indicating that the child has an appointment that will keep the immunizations current or in progress as required by said schedule and that names the date for the child’s next immunization;
(C) a statement signed and dated by a physician, physician assistant, or an advanced practice registered nurse indicating that the child has laboratory confirmed proof of immunity to natural infection, or, in the case of varicella, a statement signed and dated by a physician, physician assistant, or an advanced practice registered nurse indicating that the child has already had chickenpox based on family and/or medical history;
(D) a statement signed and dated by a physician, physician assistant, or an advanced practice registered nurse indicating that the child has a medical contraindication to immunization;
(E) a written statement that immunization is contrary to the religious beliefs and practices of the child or the parent of such child. Such statement shall be signed by the child’s parent.
(4) For each child to whom subparagraph (B) of subdivision (3) of this section applies, continued enrollment in day care for more than thirty days after the named immunization appointment shall be contingent on the provider receiving written documentation from a physician, physician assistant, or an advanced practice registered nurse stating either: that the named appointment was kept and the child received the scheduled immunizations, or that the child was unable to receive the scheduled immunizations for medical reasons and a new appointment date is named.
Exemptions: Medical and Religious
Medical Exemption Form
Religious Exemption Form
Medical exemptions are granted when an individual has experienced a previous reaction to a vaccine or if the individual has a medical contraindication against receiving a particular vaccine. The Connecticut Statutes simply say that physicians may give medical exemptions. On the child’s physical form for school entry there is an area for a medical exemption to be completed.
Religious exemptions. Connecticut also has a religious exemption, which can be claimed when vaccination conflicts with ones beliefs. Religious exemption is generally understood to be an all or nothing proposition. It is assumed that if one vaccine conflicts with ones beliefs, then they all do. Since beliefs may change, one may have been vaccinated to a point in the past, but may later decide to use the religious exemption and not further vaccinate.
Connecticut General Statutes Sections 10-204a and 19a-87b-10.
Daycare:
Sec. 19a-87b. (Formerly Sec. 17-585(b)(d))
(c) The Commissioner of Public Health shall adopt regulations, in accordance with the provisions of chapter 54, to assure that family day care homes, as defined in section 19a-77, shall meet the health, educational and social needs of children utilizing such homes. Such regulations shall ensure that the family day care home is treated as a residence, and not an institutional facility. Such regulations shall specify that each child be protected as age-appropriate by adequate immunization against diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, rubella, hemophilus influenzae type B and any other vaccine required by the schedule of active immunization adopted pursuant to section 19a-7f. Such regulations shall provide appropriate exemptions for children for whom such immunization is medically contraindicated and for children whose parents object to such immunization on religious grounds.
Public School:
Sec. 10-204a. Required immunizations.
(a) Each local or regional board of education, or similar body governing a nonpublic school or schools, shall require each child to be protected by adequate immunization against diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, rubella, hemophilus influenzae type B and any other vaccine required by the schedule for active immunization adopted pursuant to section 19a-7f before being permitted to enroll in any program operated by a public or nonpublic school under its jurisdiction. Before being permitted to enter seventh grade, a child shall receive a second immunization against measles.
Any such child who
(1)presents a certificate from a physician or local health agency stating that initial immunizations have been given to such child and additional immunizations are in process under guidelines and schedules specified by the Commissioner of Public Health; or
(2)presents a certificate from a physician stating that in the opinion of such physician, such immunization is medically contraindicated because of the physical condition of such child; or
(3)presents a statement from the parents or guardian of such child that such immunization would be contrary to the religious beliefs of such child; or
(4)in the case of measles, mumps or rubella, presents a certificate from a physician or from the director of health in such child’s present or previous town of residence, stating that the child has had a confirmed case of such disease; or
(5)in the case of hemophilus influenzae type B has passed his fifth birthday or
(6)in the case of pertussis, has passed his sixth birthday, shall be exempt from the appropriate provisions of this section. If the parents or guardians of any children are unable to pay for such immunizations, the expense of such immunizations shall, on the recommendations of such board of education, be paid by the town.
(b) The definitions of adequate immunization shall reflect the schedule for active immunization adopted pursuant to section 19a-7f and be established by regulation adopted in accordance with the provisions of chapter 54 by the Commissioner of Public Health, who shall also be responsible for providing procedures under which said boards and said similar governing bodies shall collect and report immunization data on each child to the Department of Public Health for compilation and analysis by said department.
Also see: Exemption Information
*Connecticut Statute does not require you to disclose your religion. If you do, it could be challenged.
*The Connecticut DPH’s religious exemption form:
Use the Connecticut Statute cited that matches whether it is a daycare or school age child. The statute cited in the religious exemption is for school age children. For daycare religious exemption, change the statute to correspond with daycare statue Section 19a-87b, as listed under the CTVIA CT State Law area.
*Dealing with Daycare providers: church authority does NOT have to sign the religious exemption. Citing DPH forms that show this requirement in [brackets] have been removed.
*It is an option, whether parents have their religious exemption notarized.
Proof of Immunity.
Titer tests are accepted as proof of immunity. Or physician statement confirming the student had the disease.
Delaware
Vaccine Mandates
HEALTH APPRAISAL
316. A licensee shall ensure that within one (1) month following admission, the licensee has on file an age-appropriate health appraisal conducted within the last twelve (12) months prior to admission for each child in attendance unless required by Law to be admitted without a health appraisal such as specified in the McKinney-Vento Homeless Assistance Act or any applicable local, State and Federal Laws and regulations. Health appraisals shall be certified by a health care provider and updated yearly or in accordance with the recommended schedule for routine health supervision of the American Academy of Pediatrics. The health appraisal shall include:
D. Recommendations regarding required medication, restrictions or modifications of the child’s activities, diet or care;
E. Medical information pertinent to treatment in case of emergency;
F. Documentation of any recommended or required screening or testing such as for blood-lead or tuberculosis; and
G. Documentation of the immunization status, with a listing of day, month and year of administration for each immunization required by the Division of Public Health as specified in the Appendix, Recommended Childhood and Adolescent Immunization Schedule. For current information the licensee shall contact the Division of Public Health or refer to the CDC website – http://www.cdc.gov/nip/recs/child-schedule.htm.
i. The licensee shall not permit a child to be admitted to the Center who is not age-appropriately vaccinated according to the most recent directive from the Division of Public Health unless a written plan has been established (see below) or as required by Law to be admitted without immunization(s) such as specified in the McKinney-Vento Homeless Assistance Act or any applicable local, State and Federal Laws and regulations.
ii. If a child has not received immunizations as required for the child’s age, the licensee shall require a written plan for updating the immunizations within a reasonable time frame to be submitted to the Early Childhood or School-Age Administrator within fourteen (14) days of the child’s admission or as required by Law such as specified in the McKinney-Vento Homeless Assistance Act or any applicable local, State and Federal Laws and regulations.
iii. If the additional required immunizations are not completed within the time frame specified in the written plan, the child shall be excluded from the Center until the immunizations have been obtained and written documentation of such has been submitted to the Early Childhood or School-Age Administrator.
317. A licensee shall ensure that for school-age children, a copy of the health appraisal required by the child’s school is also on file at the Center.
*Exemption
318. A licensee shall ensure that a child whose parent(s)/guardian(s) objects to immunizations on a religious basis or whose health care provider certifies that such immunization may be detrimental to the child’s health will be exempt from the immunization requirement provided that the parent(s)/guardian(s) submits to the Early Childhood or School-Age Administrator a notarized statement explaining the exemption is in compliance with State Law.
School Age Vaccine Mandates
Title 14 Education 800 Health and Safety
804 Immunizations
2.0 Minimum Immunizations Required for All School Enterers
2.1 All School Enterers shall have immunizations given up to four days prior to the minimum interval or age and shall include:
2.1.1 Four or more doses of diphtheria, tetanus, pertussis (DTaP, DTP, or other approved vaccine) or a combination of these vaccines.
A booster dose of Td or Tdap (adult) is recommended by the Division of Public Health for all students at age 11 or five years after the last DTaP, DTP or DT dose was administered whichever is later. Notwithstanding this requirement:
2.1.1.1 A child who received a fourth dose prior to his or her fourth birthday shall have a fifth dose;
2.1.1.2 A child who received the first dose of Td (adult) at or after age seven may meet this requirement with only three doses of Td or Tdap (adult).
2.1.2 Three or more doses of inactivated polio virus (IPV), oral polio vaccine (OPV), or a combination of these vaccines with the following exception: a child who received a third dose prior to the fourth birthday shall have a fourth dose.
2.1.3 Two doses of measles, mumps and rubella (MMR) vaccine. The first dose should be administered on or after the age of 12 months. The second dose should be administered after the fourth birthday. Individual combination vaccines of measles, mumps, rubella (MMR) may be used to meet this requirement.
2.1.3.1 Disease histories for measles, rubella and mumps shall not be accepted unless serologically confirmed.
2.1.4 Three doses of Hepatitis B vaccine.
2.1.4.1 For children 11 to 15 years old age, two doses of a vaccine approved by the Center for Disease Control (CDC) may be used.
2.1.4.2 Titers are not acceptable in lieu of completing the vaccine series and a disease history for Hepatitis B shall not be accepted unless serologically confirmed.
2.1.5 Varicella vaccine is required beginning in the 2003-2004 school year with kindergarten. One grade shall be added each year thereafter so that by the 2015-2016 school year all children in grades kindergarten through 12 shall have received the vaccination. Beginning in the 2008-2009 school year new enterers into the affected grades shall be required to have two doses of the Varicella vaccine. The first dose shall be administered on or after the age of twelve (12) months and the second at kindergarten entry into a Delaware public school. A written disease history, provided by the health care provider, parent, legal guardian, Relative Caregiver or School Enterer who has reached the statutory age of majority (18), 14 Del.C. §131(a)(9), will be accepted in lieu of the Varicella vaccination. Beginning in the 2008-2009 school year, a disease history for the Varicella vaccination must be verified by a health care provider to be exempted from the vaccination.
2.2 Children who enter school prior to age four (4) shall follow current Delaware Division of Public Health recommendations. 10 DE Reg. 1807 (06/01/07) 11 DE Reg. 666 (11/01/07)
3.0 Certification of Immunization
3.1 The parent, legal guardian, Relative Caregiver or a School Enterer who has reached the statutory age of majority (18), 14 Del.C. §131(a)(9), shall present a certificate specifying the month, day, and year that the immunizations were administered by a licensed health care practitioner.
3.2 According to 14 Del.C. §131, a principal or person in charge of a school shall not permit a child to enter into school without acceptable evidence of immunization. The parent, legal guardian, Relative Caregiver or a School Enterer who has reached the statutory age of majority (18), 14 Del.C. §131(a)(9), shall be notified of this requirement in writing. Within 14 calendar days after notification, evidence must be presented to the school that the basic series of immunizations has been initiated or has been completed.
3.3 A school enterer may be conditionally admitted to a Delaware school district by presenting a statement from a licensed health care practitioner who specifies that the School Enterer has received at least:
3.3.1 One dose of DTaP, or DTP, or DT; and
3.3.2 One dose of IPV or OPV; and
3.3.3 One dose of measles, mumps and rubella (MMR) vaccine; and
3.3.4 The first dose of the Hepatitis B series; and
3.3.5 One dose of Varicella vaccine as per 2.5.
3.4 14 DE Admin. Code 901 Education of Homeless Children and Youth 6.0 states that “School districts shall ensure that policies concerning immunization, guardianship and birth certificates do not create barriers to the school enrollment of homeless children and youth”. To that end, school districts shall as stated in 14 DE Admin. Code “assist homeless children and youth in meeting the immunization requirements”.
3.5 If the school enterer fails to complete the series of required immunizations the parent, legal guardian, Relative Caregiver or a school enterer who has reached the statutory age of majority (18), 14 Del.C. §131(a)(9), shall be notified that the School Enterer will be excluded according to 14 Del.C. §131. 10 DE Reg. 1807 (06/01/07)
Exemptions: Medical and Religious
5.0 Exemption from Immunization
5.1 Exemption from this requirement may be granted in accordance with 14 Del.C. §131 which permits approved medical and notarized religious exemptions.
5.2 Alternative dosages or immunization schedules may be accepted with the written approval of the Delaware Division of Public Health. 10 DE Reg. 1807 (06/01/07)
14 Del. C. § 131 (2007)
§ 131. Public school enrollees’ immunization program; exemptions
(5) Provision for exemption from any or all of the immunization program prescribed for a particular enrollee upon a written statement from a physician, i.e., medical doctor or doctor of osteopathy, stating that the enrollee should not receive the prescribed immunization or immunizations required in the basic series because of the reasonable certainty of a reaction detrimental to that person. A history of clinical illness of measles or rubella shall not be accepted as cause for exemption;
*(6) Provision for exemption from the immunization program for an enrollee whose parents or legal guardian, because of individual religious beliefs, reject the concept of immunization. Such a request for exemption shall be supported by the affidavit herein set forth:
AFFIDAVIT OF RELIGIOUS BELIEF
STATE OF DELAWARE
……………… COUNTY
1. (I) (We) (am) (are) the (parent(s)) (legal guardian(s)) of
……………………………………………………………………
Name of Child
2. (I) (We) hereby (swear) (affirm) that (I) (we) subscribe to a belief in a relation to a Supreme Being involving duties superior to those arising from any human relation.
3. (I) (We) further (swear) (affirm) that our belief is sincere and meaningful and occupies a place in (my) (our) life parallel to that filled by the orthodox belief in God.
4. This belief is not a political, sociological or philosophical view of a merely personal moral code.
5. This belief causes (me) (us) to request an exemption from the mandatory school vaccination program for…………………………………
Name of Child
……………………………………………
Signature of Parent(s) or Legal Guardian(s)
SWORN TO AND SUBSCRIBED before me, a registered Notary Public, this
………. day of …………, 20……
……………………………………….(Seal)
Notary Public
(7) Provision that, in the event that the Division of Public Health of the Department of Health and Social Services of the State declares that there is throughout the State or in a particular definable region of the State an epidemic of a vaccine preventable disease, any child who is enrolled in a public school and who has been exempt from the immunization program for any of the causes authorized herein shall be temporarily excluded from attendance at the public school. Rules and regulations of the Department shall provide that in the event of such temporary exclusion, it will be the responsibility of the school and the parents or legal guardian of the enrollee to assist him or her in keeping up with his or her school work and that no academic penalty shall be suffered by the enrollee upon return to school if the student has maintained his or her relationship with the school through the assignments prescribed. An enrollee so temporarily excluded shall be authorized to return to school upon the lifting by the Division of Public Health of the epidemic declaration;
District of Columbia
Daycare and School Age Vaccine Requirements
D.C. Code § 38-502 (2007) § 38-502. Certification of immunization required [Formerly § 31-502]
No student shall be admitted by a school unless the school has certification of immunization for that student, or unless the student is exempted pursuant to § 38-506.
D.C. Code § 38-505 (2007) § 38-505. Attendance without certification [Formerly § 31-505]
A school shall permit a student to attend for not more than 10 days while the school does not have certification of immunization for that student. If immunization requires a series of treatments that cannot be completed within the 10 days, the student shall be permitted to attend school while the treatments are continuing if, within the 10 days, the school receives written notification from whomever is administering it that the immunization is in progress.
Exemptions are Religious and Medical
D.C. Code § 38-506 (2007) § 38-506. Exemption from certification [Formerly § 31-506]
No certification of immunization shall be required for the admission to a school of a student:
(1) For whom the responsible person objects in good faith and in writing, to the chief official of the school, that immunization would violate his or her religious beliefs; or
(2) For whom the school has written certification by a private physician, his or her representative, or the public health authorities that immunization is medically inadvisable.
Health form with Medical Exemption Section
*religious exemption must be written and notarized:
All religious exemptions must be submitted to the school Principal & must be accompanied by a signed notarized statement from parent or guardian. Child care and Head Start children must obtain exemptions from child care or Head Start Director.
Florida
Daycare and School Age Vaccine Mandates:
B. Statutory Authority:
These guidelines describe the requirements for compulsory immunizations for admittance and attendance under the following authority:
1. Public/non-public preschools and schools, K-12: section 1003.22,
Florida Statutes, and Rule 64D-3.046, Florida Administrative Code.
2. Licensed childcare facilities: section 402.305, Florida Statutes, and Rule 65C-22.006, Florida Administrative Code.
3. Licensed family daycare homes: section 402.313, Florida Statutes, and Rule 65C-20.011, Florida Administrative Code.
4. Licensed specialized childcare facilities for the care of mildly ill children: section 402.305, Florida Statutes, and Rules 65C-25.002 and 25.008, Florida Administrative Code.
5. Family Self Sufficiency: section 414.13, Florida Statutes, and Rule 65A-4.216, Florida Administrative Code.
Prior to entry, attendance or transfer to preschools, schools (K-12), licensed childcare facilities, and family daycare homes, each child shall have on file a Florida Certification of Immunization, DH 680 (see Section IV), documenting the following:
A. Public/Non-Public Schools K-12 (children entering, attending, or transferring to Florida schools):
Four or five doses of diphtheria, tetanus, and pertussis vaccine
Three or four doses of polio vaccine
Two doses of measles, mumps, and rubella vaccine1
Two or three doses of hepatitis B vaccine
One dose of varicella vaccine (kindergarten effective school year 2001/2002, then each year an additional grade)
Two doses of varicella vaccine (kindergarten effective school year 2008/2009, then each year an additional grade)2
B. Public/Non-Public Pre-K3 (age-appropriate doses as indicated):
Diphtheria, tetanus, and pertussis vaccine
Polio vaccine
Measles vaccine
Mumps vaccine
Rubella vaccine
Hepatitis B vaccine
Varicella vaccine (effective school year 2001/2002)
Haemophilus influenzae type b (Hib) vaccine
C. Public/Non-Public Schools Seventh Grade:
Effective with the 2009/2010 school year4, In addition to all other compulsory school immunizations, children entering, attending, or transferring to the seventh grade in Florida schools are required to complete the following:
One dose of tetanus-diphtheria-pertussis vaccine (Tdap)
D. Licensed childcare facilities and family daycare homes:
Children entering or attending licensed childcare facilities and family daycare homes shall have received as many of the following age-
1 Effective for K to 12 2008/2009:
2nd dose of mumps and rubella. Preferably as two doses of measles, mumps, rubella and varicella vaccine in the combined form (MMRV).
2 Effective for 2008/2009 for kindergarten entrance. Each subsequent year the next highest
grade will be included.
3 If in a grade covered by the requirement.
4 With each subsequent year, the next highest grade will be included.
Virtual School and Home Education:
Students that participate in any public or private school campus-based activities are required to have age-appropriate vaccines with the proper documentation.
Clarifications/Exceptions to Immunization Requirements
A. Temporary Medical Exemption (DH 680 Part B):
Any child who has incomplete documentation of vaccination for the required number of doses should be admitted after the first dose(s) and issued a Temporary Medical Exemption (DH 680 Part B) and scheduled for the next dose(s) according to age and dosage spacing.
B. Diphtheria, Tetanus, Pertusis (DTP/DTaP/DT/Tdap):
1. The fifth dose of diphtheria, tetanus, pertussis vaccine (DTP or DTaP), should be given on or after the child’s fourth birthday and prior to entry into kindergarten.
2. If the fifth dose of DTP/DTaP vaccine was administered prior to the fourth birthday, a sixth dose of DTP/DTaP is NOT required. However, it is recommended that a professional medical evaluation be obtained to see if additional immunizations are needed for the child’s protection.
3. If the fourth DTP/DTaP dose is administered on or after the fourth birthday, the fifth DTP/DTaP is NOT required.
4. Pediatric diphtheria-tetanus (DT) vaccine is an acceptable substitute for DTP/DTaP vaccine if pertussis vaccine cannot be given for medical reasons. The reason(s) for contraindication to pertussis-containing vaccine must be documented, vaccine doses must be documented on DH 680, and Part C (Permanent Medical Exemption) must be completed, in addition to Part A or Part B.
5. Students who started their immunizations after seven years of age should receive a total of three doses of adult tetanus-diphtheria (Td) vaccine. If age-appropriate, Tdap should be used to replace one dose of the Td, which will meet 7th grade requirement.
6. Any dose of Td/Tdap administered after receipt of tetanus diphtheria containing vaccine at 4 to 6 years of age and before the documented on the DH 680 to meet the 7th grade requirement. A temporary medical exemption may be provided 5 years from the last Td, at which time Tdap can be administered.
C. Polio (IPV/OPV):
1. The fourth dose of polio vaccine should be given on or after the child’s fourth birthday and prior to entry into kindergarten.
2. If the fourth dose of polio vaccine was administered prior to the fourth birthday, a fifth dose of polio is NOT required. However, it is recommended that a professional medical evaluation be obtained to see if additional immunizations are needed for the child’s protection.
3. If the third polio primary dose is administered on or after the fourth birthday, the fourth polio dose is not required. This exception for only three doses of polio vaccine does not apply when the sequential IPV/OPV regimen was administered, in which case four doses of any combination is considered a complete poliovirus vaccination series.
4. Students who started their immunizations after seven years of age should receive a total of three doses of polio vaccine.
D. Measles, Mumps, Rubella (MMR):
The second dose of the measles, mumps and rubella vaccine is recommended on or after the child’s fourth birthday and prior to entry into kindergarten. MMR or measles, mumps, rubella and varicella (MMRV) vaccine, is preferred over separate injection of equivalent component vaccines. (MMRV vaccine is licensed and indicated for simultaneous vaccination against measles, mumps, rubella, and varicella among
children 12 months through 12 years of age).
Students who are already enrolled in grades 1 through 12 with a valid DH 680 and were admitted with two measles, one mumps and one rubella immunization should not be excluded. However, if their records are reviewed, they should be advised to either update their records or receive a second MMR and be issued an updated DH 680.
Documentation of 2 MMRs will be required for each subsequent year in the next highest grade in addition to any student entering a Florida school for the first time.
E. Haemophilus influenzae type b (Hib):
Haemophilus influenzae type b (Hib) vaccination is required for public/private preschool, childcare, and family daycare home attendees from two months through 59 months of age. The number of doses required for Hib vaccination varies, depending on the child’s age and type of vaccine received.
F. Hepatitis B:
1. Children who have no documentation of the hepatitis B vaccine series should be admitted after the first dose, issued a temporary medical exemption, and scheduled for the next appropriate dose.
2. An alternate two-dose hepatitis B vaccine series for adolescents 11 through 15 years of age has been approved. Children in this age group who receive the two-dose series should be considered in compliance with Florida’s hepatitis B immunization requirement for school entry and attendance.
G. Varicella:
1. Two-dose requirement:
Beginning with the 2008/2009 school year, children entering kindergarten will be required to receive two doses of varicella vaccine. The light gray highlighted area below indicates the year the two-dose requirement becomes effective. Each subsequent
year thereafter, the next highest grade will be included in the requirement. The black highlighted area indicates grades that fall under the one-dose varicella requirement. The one-dose varicella requirement started in the 2001/2002 school year.
2. Effective July 1, 2001, children entering or attending childcare facilities or family daycare homes are required to have varicella vaccine.
3. Varicella vaccine is NOT required if there is a history of varicella disease documented by the healthcare provider in the space provided on the DH 680.
Florida Department of Health Certification of Immunization (DH 680)
A. Requirements:
Any child entering a preschool, school (K-12), licensed childcare facility or family daycare home must have a completed Florida Certification of Immunization form (DH 680) with either proof of immunization or exemption for the form to be valid. Physicians who are participants in the
statewide immunization registry, Florida SHOTS, may produce an electronically signed copy of the completed DH 680 Form directly from the system. The pre-printed DH 680 Forms or blank forms for electronic printing from Florida SHOTS are available from the county health departments, or forms can be ordered from the Department of Health Distribution Center. All children should receive a completed personal immunization record or (DH 686).
A Temporary Medical Exemption (Part B) is invalid without an expiration date.
3. If the child is not fully immunized for school (K-12), preschool, childcare facility or family daycare home entry and attendance, and cannot receive any additional vaccines at this time, complete DH 680, Part B.
Vaccine Exemptions allowed are Medical and Religious
Fla. Stat. § 1002.20 (2007)
§ 1002.20. K-12 student and parent rights
K-12 students and their parents are afforded numerous statutory rights including, but not limited to, the following:
(3) HEALTH ISSUES.
(a) School-entry health examinations. –The parent of any child attending a public or private school shall be exempt from the requirement of a health examination upon written request stating objections on religious grounds in accordance with the provisions of s. 1003.22(1) and (2).
(b) Immunizations. –The parent of any child attending a public or private school shall be exempt from the school immunization requirements upon meeting any of the exemptions in accordance with the provisions of s. 1003.22(5).
Fla. Stat. § 1003.22 (2007)
§ 1003.22. School-entry health examinations; immunization against communicable diseases; exemptions; duties of Department of Health
(1) Each district school board and the governing authority of each private school shall require that each child who is entitled to admittance to kindergarten, or is entitled to any other initial entrance into a public or private school in this state, present a certification of a school-entry health examination performed within 1 year prior to enrollment in school. Each district school board, and the governing authority of each private school, may establish a policy that permits a student up to 30 school days to present a certification of a school-entry health examination. A homeless child, as defined in s. 1003.01, shall be given a temporary exemption for 30 school days. Any district school board that establishes such a policy shall include provisions in its local school health services plan to assist students in obtaining the health examinations. However, any child shall be exempt from the requirement of a health examination upon written request of the parent of the child stating objections to the examination on religious grounds.
(5) The provisions of this section shall not apply if:
(a) The parent of the child objects in writing that the administration of immunizing agents conflicts with his or her religious tenets or practices;
(b) A physician licensed under the provisions of chapter 458 or chapter 459 certifies in writing, on a form approved and provided by the Department of Health, that the child should be permanently exempt from the required immunization for medical reasons stated in writing, based upon valid clinical reasoning or evidence, demonstrating the need for the permanent exemption;
(c) A physician licensed under the provisions of chapter 458, chapter 459, or chapter 460 certifies in writing, on a form approved and provided by the Department of Health, that the child has received as many immunizations as are medically indicated at the time and is in the process of completing necessary immunizations;
(d) The Department of Health determines that, according to recognized standards of medical practice, any required immunization is unnecessary or hazardous; or
(e) An authorized school official issues a temporary exemption, for a period not to exceed 30 school days, to permit a student who transfers into a new county to attend class until his or her records can be obtained. A homeless child, as defined in s. 1003.01, shall be given a temporary exemption for 30 school days. The public school health nurse or authorized private school official is responsible for follow up of each such student until proper documentation or immunizations are obtained. An exemption for 30 days may be issued for a student who enters a juvenile justice program to permit the student to attend class until his or her records can be obtained or until the immunizations can be obtained. An authorized juvenile justice official is responsible for follow up of each student who enters a juvenile justice program until proper documentation or immunizations are obtained.
(6)
(a) No person licensed by this state as a physician or nurse shall be liable for any injury caused by his or her action or failure to act in the administration of a vaccine or other immunizing agent pursuant to the provisions of this section if the person acts as a reasonably prudent person with similar professional training would have acted under the same or similar circumstances.
(b) No member of a district school board, or any of its employees, or member of a governing board of a private school, or any of its employees, shall be liable for any injury caused by the administration of a vaccine to any student who is required to be so immunized or for a failure to diagnose scoliosis pursuant to the provisions of this section.
Fla. Stat. § 402.395 (2007)
402.305 Licensing standards; child care facilities.–
(9) ADMISSIONS AND RECORDKEEPING.–
(a) Minimum standards shall include requirements for preadmission and periodic health examinations, requirements for immunizations, and requirements for maintaining emergency information and health records on all children.
(b) Because of the nature and duration of drop-in child care, requirements for preadmission and periodic health examinations and requirements for medically signed records of immunization required for child care facilities shall not apply. A parent of a child in drop-in child care shall, however, be required to attest to the child’s health condition and the type and current status of the child’s immunizations.
(c) Any child shall be exempt from medical or physical examination or medical or surgical treatment upon written request of the parent or guardian of such child who objects to the examination and treatment. However, the laws, rules, and regulations relating to contagious or communicable diseases and sanitary matters shall not be violated because of any exemption from or variation of the health and immunization minimum standards.
*Religious Exemption requests must be presented on DH Form 681, Religious Exemption From Immunization, which is to be issued only by county health departments.
*The DH 681 is issued ONLY by county health departments and ONLY for a child who is not immunized because of his/her family’s religious tenets or practices. If a parent requests such an exemption, the county health department staff must use the current DH 681 Form, which has been signed by the parent
affirming the written statement on the form that a religious conflict exists. This form must be issued upon request. No other information should be solicited from the parent or guardian.
*Requests for religious exemption from immunizations should be consistent with section 1003.22, Florida Statutes. Exemptions for personal or philosophical reasons are not permitted under Florida law.
*The county health department director or administrator may exclude from school, preschool, childcare facilities, or family daycare centers those children without proper documentation of immunization (or with medical/religious exemptions) for the disease for which the emergency has been declared. In the case of a childcare facility, non-cmpliance may lead to eventual closure.
IX. Immunization Requirement for Public Assistance Eligibility Under the Family
Self Sufficiency Program
A. Legal Authority:
Effective July 1, 1997, the immunization provision in Welfare Transition Program requires that preschool children, or a child of less than 5 years of age, of applicants and recipients of cash assistance must begin and complete childhood immunizations as a condition of eligibility. These requirements are in accordance with section 414.13, Florida Statutes, section 65A-4.216, Florida Administrative Code, and the immunization requirements for the Welfare Transition Program.
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