The State of Iowa requires all students to have a current immunization record on file for each student.  The state has made changes to the immunizations requirements in 2009, 2013 and in 2017 so it is important to note that certain vaccines many now be required for your child.  


  • Physical Exam (not REQUIRED but strongly RECOMMENDED)

  • 4 doses Diphtheria/Tetanus/Pertussis

  • 3 doses Polio

  • 3 doses Hib with the final dose in the series > 12 months of age  or 1 dose received > 15 months of age.

  • 1 dose Measles/Rubella > 12 months of age. ( MMR)

  • 1 dose Varicella > 12 months of age or  history of natural disease.(Chicken Pox)

  • 4 doses Pneumococcal; with one dose > 12 months of age


  • Physical exam (not REQUIRED, but strongly RECOMMENDED)

  • Lead Screening

    • Done at health care providers office~information is sent to the State of Iowa

  • Vision Screening

  • Dental Screening

    • This form is available at the school, your dental provider, or it can be found at

  • 5 doses Diphtheria/Tetanus/Pertussis with 1 dose received > 4 years of age 

  • 4 doses Polio with 1 dose received > 4 years of age.

  • 2 doses Measles/Rubella; the first dose at 12-18 months of age, second dose prior to Kindergarten

  • 3 doses Hepatitis B if born on or after July 1, 1994.

  • 2 doses Varicella;  the first dose at 12-18 months, second dose prior to Kindergarten unless the applicant has a reliable history of natural disease.

3rd Grade:

7th Grade: 

  • 1 booster dose of Tdap (tetanus, and pertussis).  

  • 1 booster dose of Meningococcal Vaccine

  • All students entering into 7th grade will be required to have these doses to have a current and compliant immunization record here at school. 

9th Grade:

  • Dental screening 

  • This form is available at the school, your dental provider, or it can be found at

12th Grade:

  •  Meningococcal Vaccine after 16 years old

  • If dose prior to 16 years old~will need a booster


Health Information 
Health Consent - All Students (Required)
Authorization for Medication Administration - any medication administered at school MUST have this form completed
Asthma Action Plan
Dental Screening Form ** required for Kindergarteners & 9th Graders
Vision Screening Form

**If you have any questions, please call the school or email