Student Immunization Record
The form below does NOT show the immunization record we have on file for your child. Submit your child's complete record ONLY if this is your first time enrolling in an MMSD school or if your child has received a new immunization.
INSTRUCTIONS TO PARENT: Complete within 30 DAYS AFTER ADMISSION. State laws 252.04 and 120.12(16) require all public and private school students to present written evidence of immunization against certain diseases within 30 school days of admission. The current age/grade specific requirements are listed below in step 3. These requirements can be waived only if a properly signed health, religious, or personal conviction waiver is filed by the school. The purpose of this form is to measure compliance with the law and will be used for that reason only. If you have questions on immunizations or how to complete this form, contact your child's school or local health department.