Immunization Commitment Form

Students entering EAGLE must demonstrate compliance with state law immunization requirements. The current student immunization age/grade requirements are listed in the table below. State law require that when schools post notice of their immunization requirements, they must also notify recipients that the recipients have the right to object to immunizations for reasons of health, religion or personal conviction and may seek a waiver of the immunization requirements.

If your child is offered a place at EAGLE School, will you have your child receive all the immunizations required for his/her age and grade?(Required)
*If your child will not be in compliance with the immunization requirements, please schedule a meeting with the Director to discuss your objections and the impact your decision may have on the rest of the student body and the staff. EAGLE School reserves the right to revoke acceptance if a child lacks the required immunizations according to Wisconsin state law.

IMMUNIZATION COMMITMENT: REQUIRED IMMUNIZATIONS

DEPARTMENT OF HEALTH SERVICES STATE OF WISCONSIN Division of Public Health Wis. Stat. §§ 252.04 and 120.12 (16) P-4402L (Rev. 6/2020) STUDENT IMMUNIZATION LAW AGE/GRADE REQUIREMENTS 2024 SCHOOL YEAR and Beyond The following are the minimum required immunizations for each age/grade level. It is not a recommended immunization schedule for infants and preschoolers. For that schedule, contact your doctor or local health department. Age/Grade: Number of Doses Pre K (2-4 years):4 DTP/DTap/DT, 3 Polio, 3 Hep B, 1 MMR, 1 Var Grade K through 6: 4 DTP/DTap/DT/TD, 4 Polio, 3 Hep B, 2 MMR, 2 Var Grade 7 through 12: 4 DTP/DTap/DT/TD, 1 Tdap, 4 Polio, 3 Hep B, 2 MMR,2 Var 1. DTP/DTaP/DT vaccine for children entering Kindergarten: Your child must have received one dose after the 4th birthday (either the 3rd, 4th, or 5th) to be compliant. (Note: a dose 4 days or less before the 4th birthday is also acceptable). 2.D = diphtheria, T = tetanus, P = pertussis vaccine. DTaP/DTP/DT/Td vaccine for all students Pre-K through 12: Four doses are required. However, if a student received the 3rd dose after the 4th birthday, further doses are not required. Note: A dose four days or less before the 4th birthday is also acceptable. 3. DTaP/DTP/DT vaccine for children entering Kindergarten: Each student must have received one dose after the 4th birthday (either the 3rd, 4th, or 5th dose) to be compliant. Note: a dose four days or less before the 4th birthday is also acceptable. 4. Tdap is an adolescent tetanus, diphtheria, and acellular pertussis combination vaccine. If a student received a dose of a tetanus containing vaccine, such as Td, within five years before entering the grade in which Tdap is required, the student is compliant and a dose of Tdap vaccine is not required. 5. Polio vaccine for students entering grades Kindergarten through 12: Four doses are required. However, if a student received the 3rd dose after the 4th birthday, further doses are not required. Note: a dose four days or less before the 4th birthday is also acceptable. 6. Laboratory evidence of immunity to hepatitis B is also acceptable. 6. MMR is measles, mumps, and rubella vaccine. The first dose of MMR vaccine must have been received on or after the 1st birthday. Laboratory evidence of immunity to all three diseases (measles and mumps and rubella) is also acceptable. Note: A dose four days or less before the 1st birthday is also acceptable. 7. Varicella vaccine is chickenpox vaccine. Students with a reliable history of varicella disease are not required to receive the Varicella vaccine. A parent or guardian may indicate that their student has had chickenpox on the Student Immunization Record form (F-04020L).

For more information about which vaccinations are necessary, please click here: