School-Age Enrollment Form
R 400.5305 Health records. Rule 305. (1) Upon enrollment and annually thereafter, the center shall obtain and keep on file at the center a signed statement from the school-age child’s parent all of the following: (a) The child is in good health with activity restrictions noted. (b) The child’s immunizations are up to date. (c) The immunization record or appropriate waiver is on file with the child’s school.
Child's Name *
Your answer
I verify that my child is in good health and that he/she is up to date on all immunizations. A copy of my child’s immunizations record or appropriate waiver is on file with the child’s elementary school. *
Parent's Signature *
Your answer
Date *
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