 |
| Stockton Borough School |
| 19 S. Main Street, Stockton, NJ 08559 |
| 609-397-2012 FAX: 609-397-2602 |
NAME:
___________________________
DATE:
____________________________
Dear
Parent/Guardian:
The
New Jersey State Department of Health has mandated minimum
immunization regulations which apply to all students attending any public or
private school in New Jersey.
Every
student born on or after January 1, 1986, shall receive at least four doses
of DTP, one does of which shall be given on or after the fourth birthday.
Every
student born on or after January 1, 1986, shall receive at least three doses of
live, trivalent, oral poliovirus vaccine (OPV), one dose of which shall be given
on or after the fourth birthday.
Every
student born on or after January 1, 1990, shall receive two (2) doses of a
measles-containing vaccine given after the first birthday, preferably MMR which
must be separated by at least one month.
Every
student born on or after January 1, 2001, shall receive three doses of
Hepatitis B vaccine.
A
recent review of your child’s immunization history indicates that to comply
with the regulations, he/she is still required to receive the immunization(s)
checked below.
This
form must be completed and returned to school by September 1, 2003.
Your assistance is completing your child’s medical records as soon as
possible is greatly appreciated. If
you are able to return the completed form prior to the close of this school
year, please do so. Failure to comply will prevent your child from entering
school in September 2003.
Diphtheria
& Tetanus Toxoid & Pertussis Vaccine _____
Poliovirus
Vaccine _____
__√__INDICATES
REQUIRED
Measles
or MMR #2 Vaccine ______
Hepatitis
B _____
Received:
______________________________
Sincerely,
Name of Vaccine
Administered
by:_________________________
Physician’s Signature
________________________
School Nurse
Date:___________________________________
_______________________________________
|
1.
DTP (Diphtheria, Tetanus toxoids and Pertussis)
A minimum of four doses.
One dose must have been given on or after the fourth birthday. (A
child with any total of five doses of DTP, DtaP, DTP/Hib, or DT will also be in
compliance with this regulation.)
2.
OPV (Oral Poliovirus Vaccine) or IPV (inactivated
Poliovirus Vaccine)
A minimum of three doses.
One dose must have been given on or after the fourth birthday.
[A child with any four doses of polio vaccine spaced by a minimum of one month
(28 days) will now also be in compliance.]
3.
MEASLES
Two doses are required. Two doses of a measles-containing vaccine given after
the first birthday and must be separated by an interval of at least one
month (28 days).
One dose must have been given on or after the
first birthday.
5.
Mumps
One dose must have been given on or after the
first birthday.
6.
Hepatitis B
Three doses are required.
In
the event the nurse finds that your child’s immunization record does not meet
the New Jersey State requirements, please take the necessary forms to your
physician. Once your child has
received the immunization that is required, please return the completed form to
the school. (Children who do not
have complete immunization records by September 1, cannot begin
kindergarten).
Suggestion: It is recommended you keep a photocopy of any information sent to the Nurse.