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Health Documents

New Immunization form

Please be aware that according to the new law, a new immunization form is now being utilized throughout the state of Kentucky. All health care providers should have copies but please remind them of this when obtaining any immunizations. Per state law, your school will not be allowed to accept any old immunization forms after July 1, 2011. Also, your school is not allowed to accept immunization records with only the most recent shot/s documented. The complete vaccination history listed must be listed.


Before Entering Preschool/Kindergarten

¨       Medical examination before school entry.

¨       Vision Exam by Optometrist or Ophthalmologist for 3-6 year old school entry.

¨       All newly enrolled 5-6 year olds must have a dental screening.

Per 902 KAR 2:060:  A current immunization certificate must be on file for a child to attend school.  

Immunization Certificate must include:

Starting in the 2018-2019 school year, Hepatitis A vaccine is required for ALL students Preschool - grade 12.   



Booster dose at 4-6 years - before school entry.


Dose at 4-6 years - before school entry.


Second dose - before school entry if child is age 5 or younger


Minimum of one dose required if child is less than 5 years old.

Hepatitis A Two shot series given 6 months apart.

Hepatitis B

Three shot series - If not previously vaccinated.


2 doses required for school entry if child is age 5 or younger.Verification of a history of chicken pox has to be obtained from a physician.


* Printable Exam Forms located below


Before Entering Sixth Grade

Medical examination before sixth grade entry.

Immunization Certificate must be updated to include:



Measles, Mumps, Rubella - A second dose is required if not already received.

 Hepatitis A Two shot series given 6 months apart.

Hepatitis B

Three shot series - If not previously vaccinated.


Tetanus vaccine required for 6thgrade if child is 11 or 12.If child received a TD (another form of tetanus) between the ages of 7 – 10, they are still required to have a Tdap for school entrance.One form of Tdap called Boostrix is actually approved to be given starting at age 10 but the form of Tdap called Adacel is only approved for ages 11 and up.

Meningococcal Vaccine

Meningococcal Vaccine (for meningitis) is required for 6thgrade school entrance if your child is age 11 or 12.The CDCrecommends that the Meningococcal vaccine be given starting at age 11.

Varicella Vaccine

A second dose of Varicella Vaccine (for chicken pox) is required for 6th grade school entrance if not previously obtained.If your child has a history of the chicken pox disease, state law requires verification from their health care provider.


* Printed Exam Forms located below


High School Requirements

High school students are required to have received all shots as listed above for grade 6 entry.

Starting in the 2018-2019 School year, students age 16 and older need a 2nd Meningococcal ACWY vaccine.

Tdap (Tetanus) - if student has not received a dose of Tdap since age 10, one dose of Tdap is recommended in high school.