PARENT MEMO: FIRST NOTICE
2012-2013 IMMUNIZATION REQUIREMENTS
DATE HERE
Dear Parent/ Guardian of USE MERGE FIELD HERE:
The NYC Department of Health requires that all students entering the 6th grade receive the
tetanus booster “Tdap” vaccine which contains tetanus toxoids, diphtheria and acellular
pertussis (Tdap). Failure to have your child properly immunized may lead to exclusion from
school.
In addition to the Tdap vaccine, your scholar may have not received several other mandated
vaccinations. Please check the list below of vaccinations required by the NYC Department of
Health.
Proof of Immunization must be submitted to the Achievement First YOUR SCHOOL NAME
HERE School main office no later than DATE HERE. Missing immunization documentation is a
violation of the NYC Department of Health.
Any vaccinations marked with an “X” below, are the shots which your scholar did not
receive/has not yet received or does not have documentation on file:
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TDAP
OPV
MMR
MEASLES
MUMPS
RUBELLA
HBV
VARICELLA
We have attached an immunization form for your child’s doctor to complete. It should be
dated and stamped by his/her physician and returned to AF Endeavor’s main office no later
than DATE HERE.
All returned immunization forms should only be submitted to the Main Office on the first
floor. For professional or technical questions, please call the Bureau of Immunization at 212676-2259 or the main office at YOUR SCHOOL NUMBER HERE and ask to speak to our
CONTACT NAME HERE.
Respectfully Yours,
Principal Name and Signature Here