Wisconsin Immunization Program
Immunization Requirements
School Requirements
- School Immunization Requirements Booklet 2011-12 (PDF, 456 KB)
- 2010-11 and 2011-12 School Age/Grade Reqs.
(English) (PDF,
28 KB)
(Spanish) (PDF,
29 KB)
(Hmong) (PDF, 24 KB)
- Varicella, Tdap, and PCV (Pneumococcal) School Requirements
- School Based Clinic Consent-Tdap/Varicella
(English) (PDF, 55 KB)
(Spanish) (PDF, 29 KB)
(Hmong) (PDF, 29 KB)
- School Based Clinic Consent-Tdap only
(English) (PDF, 26 KB)
(Spanish) (PDF, 26 KB)
(Hmong) (PDF, 26 KB)
- Authorization To Receive Tetanus, diphtheria, acellular pertussis (Tdap), Varicella, Meningococcal Conjugate (MCV4) and/or Human Papilloma Virus (HPV) Vaccine(s)
(English) (PDF, 29 KB)
(Spanish) (PDF, 130 KB)
(Hmong) (PDF, 34 KB)
- School Report
to Local Health Department (PDF, 21 KB)
- School Report
to the District Attorney (PDF, 10 KB)
-
Letter to School Principals (PDF, 44.3 KB)
- School Fact Sheet for Parents
(English) (PDF,
96 KB)
(Spanish) (PDF,
80 KB)
(Hmong) (PDF,
81 KB)
- Student Immunization Record
(English) (PDF, 46 KB)
(Spanish) (PDF, 52 KB)
(Hmong) (PDF, 52 KB)
Daycare Requirements
- Day Care Immunization Assessment Booklet 2011-12 (PDF, 1 MB)
- Day Care
Fact Sheet for Parents (PDF, 25 KB)
- Day Care
Immunization Record (PDF, 83 KB)
- Day Care
Immunization Record in Spanish (PDF, 14
KB)
Additional Resources
- Chapter
DHS 144 Immunization of Students (exit
DHS; PDF, 38 KB)
- Wisconsin
Statute 252.04 (exit DHS; PDF, 105 KB).
The
Immunization portion can be found on pg. 2 of the
document.
- Chapter
DHS 124 Hospitals (exit DHS;
PDF, 179 KB)
- History of Wisconsin Student Immunization Law
PDF: The free Adobe Reader® software is needed to view and print portable document format (PDF) files. Learn more.
Last Revised: January 27, 2012
|
