IMPORTANT FALL UPDATE FROM THE SCHOOL NURSE
Dear Parent/Guardian of incoming 6th graders,
SUBJECT: Required Additional Vaccine for 6th Grade – Fall 2014
Incoming 6th graders in Washington State will be required to show proof of:
One Tdap vaccine, if student is 11 years old. (Required for school attendance!)
Please complete the bottom portion of this form with the necessary information and then return this
form to your child’s school as soon as possible. Or, if these vaccines are obtained over the summer,
take this form to their middle school. Please call the middle school for their summer hours.
For those students who still need to get their vaccines, please contact your child’s licensed health care
provider or call the following for FREE/LOW COST immunizations:
Mary Bridge Immunization sites:
(253) 403-1767
St Joseph’s Immunization sites:
(253) 426-6938
Please take your child’s immunization records with you and be sure to have your child immunized as
soon as possible to avoid the rush (and possible vaccine shortages) in the summer. It is very helpful to
get the information to your child’s school as soon as possible.
Thank you!
School Nurse
Telephone:
Student name_____________________________________________________
Tdap vaccine date: ________________________
I give permission to add the above vaccine information to my son’s/daughter’s Certificate
Of Immunization Status form which is on file at his/her current school.
Parent/Guardian Signature _________________________________ Date____________
(12/2013)