Immunization Requirements

How to fill out the immunizations "Pink Card" (if it's not in your new student packet, please ask for one):

Fill in the top portion of the Pink Card (Student Name, Address, Parent Signature, etc.).
Attach a copy of your student's immunization record to the back of the Pink Card.
If the student has had the chickenpox, please sign the "My student has had the chickenpox disease" box in the lower right corner.
If you prefer, you may take the Pink Card to your health care provider and they can complete it in its entirety.

2010-2011 School Year

Utah Immunization Rule for Students R396-100

In order to attend school, a student must have proof of receiving the following immunizations:

Grades K - 6 -- students born AFTER July 1, 1996

5 DTP (4 if the 4th dose given after the 4th birthday)
4 Polio/IPV (3 if 3rd dose given after the 4th birthday)
2 Measles/Mumps/Rubella
2 Hepatitis A
3 Hepatitis B
1 Varicella (or history of having Chicken Pox disease, parents must sign verification in immunization pink card)

Grade 7 - 8 -- students born AFTER July 1, 1993

5 DTP (4 if the 4th dose given after the 4th birthday)
4 Polio (3 if 3rd dose given after the 4th birthday)
2 Measles/Mumps/Rubella
2 Hepatitis A
3 Hepatitis B
1 TDaP/TD Booster
1 Varicella (or history of having Chicken Pox disease, parents must sign verification on immunization pink card)

Grade 9 - 11 -- students born AFTER July 1, 1993

5 DTP (4 if the 4th dose given after the 4th birthday)
4 Polio (3 if the 3rd dose given after the 4th birthday)
2 Measles/Mumps/Rubella
3 Hepatitis B
1 TDaP/TD Booster
1 Varicella (or history of having Chicken Pox disease, parents must sign verification on immunization pink card)

Grade 12 -- students born BEFORE July 1, 1993

5 DTP (4 if the 4th dose given after the 4th birthday)
4 Polio (3 if 3rd dose given after the 4th birthday)
2 Measles/Mumps/Rubella

Conditional Enrollment and Exclusion: R396-100-7

A student may be allowed to attend school conditionally if the student has received one dose of each required vaccine and be on schedule for subsequent immunizations. If calendar month past due the school must immediately exclude from school.

Immunization Exemption: 53A-11-302

A student may be exempt from immunizations for medical or personal belief reasons. Exemption forms are available at Summit County Health Department and may be available through your physician. The parent or guardian must give the school the original copy of the exemption form, to be kept on file at the school. Exemption forms cannot be faxed to the school. In the event of an outbreak, students who have claimed an exemption or are on conditional enrollment and have not received the immunization for which there is an outbreak are to be excluded from school.

If you have questions about school immunizations, contact your School Nurse, or call 1-800-275-0659