HomeMy WebLinkAbout3004F3 Immunization Letter to Parents
STUDENTS 3004F3
Bonneville Joint School District 93 3004F3 Immunization Letter to Parents
(12/20)
Date
Dear :
Vaccinations are important in the prevention of infectious disease and may save your child’s life
during an outbreak. Your child, (student’s name) has not met the minimum immunization
requirements for school entry required by Idaho Code 39-4801 and District policy 3004
Immunization Requirements.
Our records show that your child needs the following immunization(s):
� DTaP Dose Number: 1 2 3 4 5
� Polio Dose Number: 1 2 3 4
� Hepatitis B Dose Number: 1 2 3
� MMR Dose Number: 1 2
� Varicella Dose Number: 1 2
� Hepatitis A Dose Number: 1 2
� Tdap Booster Dose Number: 1
� Meningococcal Dose Number: 1 2
According to state law, we cannot allow your child to attend school unless we receive
evidence that the above requirements are met or a valid medical, religious or personal
exemption recorded on the State of Idaho form 3004F1 Idaho School Immunization
Requirements Exemption or a signed statement that includes name of the student, DOB,
a statement indicating that the student is exempt from immunization for religious or
other objections, and the signature of the parent, custodian, or legal guardian is on file
by this date: .
PLEASE DO ONE OF FOLLOWING IMMEDIATELY:
1. Take this form along with your child’s immunization record to your medical provider or the
local health department to get the needed immunization(s) and bring your child’s updated
immunization record back to your child’s school.
2. If the copy of your child’s immunization record shows your child has already received these
immunizations, bring us the records to your child’s school. Your child’s record must include a
date for the immunizations circled above and the medial provider’s signature or stamp.
3. For children requiring more than one dose of any one vaccine, the series must be started by
the above date. A completed 3004F2 Idaho Conditional Admission to School (Schedule of
Intended Immunizations) Form must be returned to the school. The child will be admitted on
the condition that they will receive needed doses as they become due.
Once your child has received the above immunizations, a copy of the child’s immunization
record must be provided to the appropriate school official so that school records can be
updated. Failure to receive the above vaccinations or a valid exemption record before the
deadline will result in your child being excluded from school in accordance with IDAPA 16.02.15,
section 102.03.
Thank you for your cooperation;
Principal,