PA Dept of Health - Private Dental Form
(Dental exam required for initial entry to school, then grades 3 & 7)
PA Dept of Health Private Physical Exam Form
(Physical exam required for entry to school, then grades 6 & 11)
PA Dept of Health Medical Certificate (be sure to print in landscape mode so that it fits on the page)
Children's Health Insurance Program (CHIP)
ADDITIONAL immunization requirements
Do Not Delay:
Please make an appointment with your child's healthcare provider to obtain the necessary immunizations prior to the start of the school year.
*The Erie County Department of Health provides immunizations to children, adolescents, and adults. For information on the eligibility criteria for vaccines and appointments, please call 814-451-6777. Parents or guardians over the age of 18 years must accompany children under 18 years to an appointment. Previous Immunization Records must be brought to the appointment.
Students Need the Following Immunizations for School Attendance:
Children in all grades (K-12)
4 doses DPT* (Tetanus, diphtheria and acellular pertussis), (1 dose on or after the 4th birthday)
4 doses Polio* (4th dose on or after the 4th birthday and at least 6 months after the previous dose)
3 doses Hepatitis B*
2 doses Measles, Mumps and Rubella (MMR)*
2 doses Varicella* (chickenpox) or a documented history of disease
Children entering 7th Grade
1 dose Menactra* (meningitis) at age 11 or older
1 dose Tdap (Tetanus/Diphtheria/Acellular Pertussis)
** If not given in 7th grade, children entering 8th - 11th grades will need these immunizations to start the current school year.
Children entering 12th Grade
A second dose of Menactra is required after 16 years of age or entry into 12th grade
For ALL immunizations in ALL Grades:
Children must have one of each of the immunizations listed above in order to start school. If this information is not provided your child will be excluded from attendance on day 1 of the school year unless your child has a medical or religious/philosophical exemption on file in the nurse's office. Even if your child is exempt from immunizations, he or she may be excluded from school during an outbreak of vaccine preventable disease.
Parents/guardians will be given 5 school days in which to get the next medically appropriate dose AND provide a Medical Certificate (available here - print in landscape mode - or contact the School Nurse for a copy) completed by the medical provider (Physician, Nurse Practitioner/Physician Assistant, State Health Center), which indicates the exact dates ALL the remaining doses are scheduled. If this information is not provided, your child will be excluded from attendance on day 6 of the school year.
When immunizations are not medically appropriate to be given in the first 5 days of school, a parent/guardian must provide a Medical Certificate (available here - print in landscape mode - or contact the School Nurse for a copy) completed by the medical provider (Physician, Nurse Practitioner/Physician Assistant, State Health Center), which indicates the exact dates ALL the remaining doses are scheduled. If this information is not provided, your child will be excluded from attendance on day 6 of the school year.
If you have questions, please contact:
High School & Middle School • Ms. K. Sundberg • x1226
Elementary Schools • Mrs. L. Luzier • x2269