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Minnesota Statutes Section 121A.15 requires children enrolled in a Minnesota school to be immunized against certain diseases, allowing for specified exceptions. This form is designed to provide the school with information required by the law. Students not in compliance-i.e., their immunizations are not up-to-date-will be excluded from school.

A copy of the student's current immunization record must be on file, at school.

Check now with your family doctor or clinic to see if your child(ren) has all the immunizations required for their age. If the student receives an immunization during the summer months, send by mail, fax, or drop off at the school the date (day, month, and year) of the shot received. If you have questions or do not have insurance contact the nurse at your child's school for assistance.

Parents may get a legal exemption for medical reasons or conscientiously held beliefs.

Required Immunizations for Kindergarten Children:
• 5 DTaP (diphtheria, tetanus, and pertussis): last dose on/after 4 years
• 4 Polio: last dose on/after 4 years
• 2 MMR (measles, mumps, rubella)
• Hepatitis B Series
• 2 Varicella or documented history of the disease

Required Immunizations for Grades 7-12:

Same as above plus;
Tdap instead of Td
The links below provide detailed information on required immunizations and a form for you to complete and return to your health office.

Student Immunization Requirement English

Student Immunization Requirement Spanish

Student Immunization Form

Student Immunization Form -Karen

Student Immunization Form- Spanish