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Part 4: Proof of Immunization
To learn in a general student population, Missouri law requires that you provide “documentation of up-to-date immunization status, including month, day, and year of each immunization.”

Additional resources from the Missouri Department of Health (optional reading)
health.mo.gov/living/wellness/immunizations/schoolrequirements.php
health.mo.gov/living/wellness/immunizations/pdf/1819surveypacket.pdf

General Information
Guardian: First Name *
Guardian: Last Name *
Guardian: Phone *
Guardian: Email *
If you remember, please put the same email that you put for "Part 1: Student & Parent Information." Kairos will often communicate through email, so this should be an account you check regularly.
Student: First Name *
Student: Last Name *
Immunization Forms
Please submit scans/photos of documentation for the following immunizations. If you do not have the appropriate record, you can request it from your student's pediatrician.
Evidence of 4+ doses of vaccination for DTaP/DTP/DT. *
DTaP/DTP/DT stands for Diphtheria, Tetanus, Acellular Pertussis. Different brand and abbreviations of vaccine include: Acel-Imune, Certiva, Daptacel, DTaP, Infanrix, Tripedia, Kinrix (Combined with IPV), Pentacel (Combined with IPV and Hib), Tetramune (Combined with Hib) abbreviated TTR, TriHIBit (Combined with Hib) (DTaP/Hib), Pediarix (Combined with IPV and Hep B).
Required
Evidence of 4+ doses of vaccination for DTaP/DTP/DT (Diphtheria, Tetanus, Acellular Pertussis). *
Different brand and abbreviations of vaccines include: Acel-Imune, Certiva, Daptacel, DTaP, Infanrix, Tripedia, Kinrix (Combined with IPV), Pentacel (Combined with IPV and Hib), Tetramune (Combined with Hib) abbreviated TTR, TriHIBit (Combined with Hib) (DTaP/Hib), Pediarix (Combined with IPV and Hep B).
Required
Evidence of 3+ doses of vaccination for IPV (Polio). *
Different brand and abbreviations of vaccines include: eIPV, OPV (Oral Polio), IPV, TOPV (Oral Polio), Ipol, Orimune (Oral Polio), Pediarix (Combined with DTaP and Hep B), Pentacel (Combined with DTaP and Hib), Kinrix (Combined with DTaP).
Required
Evidence of 2 doses of vaccination for MMR (Measles, Mumps, Rubella). *
Different brand and abbreviations of vaccines include: MMR, M-M-R II, MMRV (Measles, Mumps, Rubella combined with Varicella), ProQuad (Measles, Mumps, Rubella combined with Varicella)
Required
Evidence of 3+ doses of vaccination for Hepatitis B. *
Different brand and abbreviations of vaccines include: Engerix-B, HBV, Hep B, Heptavax, Recombivax-HB, Comvax (Combined with Hib), Pediarix (Combined with DTaP and IPV), Twinrix (Combined with Hep A).
Required
Evidence of 2 doses of vaccination for Varicella (Chickenpox). *
Different brand and abbreviations of vaccines include: VAR, Varivax, MMRV (Varicella combined with Measles, Mumps, Rubella), ProQuad (Varicella combined with Measles, Mumps, Rubella).
Required
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