Prairie Creek Elementary School
On-‐Line Enrollment Step 2 Document 2011/2012
PRAIRIE CREEK ELEMENTARY “Home of the Panthers” 654 YMCA Drive Andover, KS 67002 316-218-4830 www.usd385.org
Shelley Jonas, Principal
July 2011
Mark Your Calendars: August 1st School office open Hours 8:00-12:00 and 1:00-4:00 August 9th Online Enrollments Completed August 11th K-5th Grade Class Assignments mailed home. August 16th Meet Your Teacher Night 6:30-7:30 p.m. August 18th First Day of school for 1st-5th grade students August 18th-19th Kindergarten Screenings (by scheduled time) August 22nd First day of school for Pre-K/EC and Kindergarten students
School Hours 8:35 a.m. - 3:35 p.m. AM EC/Pre-K & Kindergarten 8:35 - 11:35 a.m. PM EC/Pre-K & Kindergarten 12:35-3:35 p.m. School begins at 8:35 a.m., students should arrive no earlier than 8:15 a.m. If a child arrives after 8:35 a.m., they must check in through the office and will be counted as tardy. If students arrive earlier than 8:35 a.m., they must enter through the north doors, which open at 8:15 a.m..
Classroom Placement Classroom teacher assignments will be mailed to you on Thursday, August 11th. Watch for the postcard in your mailbox!
Open House Prairie Creek will have “Meet Your Teacher” night on Tuesday, August 16th from 6:30-7:30 p.m. Student Handbooks will be available that evening from your teacher.
PTO Prairie Creek has an active Parent Teacher Organization (PTO). If you are interested in becoming a part of the Prairie Creek PTO, please fill out the committee sign-up sheet, which will be available with the online enrollment forms.
2011-2012 Elementary School Fee Schedule Student’s Name: ____________________________________ Grade: _______ $__________ Early Childhood Fee – $65 (Peer Models; additional $120 per semester) $__________ Half Day Kindergarten Enrollment Fee - $65 th
$
______ All Day Kindergarten & 1st thru 5 Grade Enrollment Fee - $75
$__________ Technology Fee - $25 (Early Childhood/Half Day K $12.50) $__________ Total
Enrollment Fee Payment Options
Make checks payable to Prairie Creek Elementary School, or Pay online at www.usd385.org
Food Service Payment Options
Make checks payable to USD #385 Food Service, or Pay online at www.usd385.org
Office Use: This form is for all students who are NEW to the district. Fees Collected: Total Amount $______________Check#_____________Cash______________
The A-Line———— Transportation service for those who live less than 2.5 miles from their school Andover Public Schools will make available feebased transportation for all students in the district who live less than 2.5 miles from their school and choose to ride the bus.
Students who qualify for free or reduced lunches may use this program for free.
Eligibility for this program is based on the student’s home address, not from the location the student boards the bus. Students must be registered and fees must be paid before transportation can begin. Registration must be made by parents — not by students or babysitters. The program fee is $100 per year per student. Pro-rating will be available to new students only. There is a maximum fee of $150 per year for all students in one family who live at the same address. Students in the program must go to the nearest established bus stop for pick up. There are no discounts for students in sports or other activities that make it necessary for the student to use the bus only once a day— the cost remains the same whether the student(s) ride one way or both ways.
Because the district receives state aid for transporting students who live 2.5 miles or more from their school, the district will continue to provide free bus transportation for all of those students. To use the A-Line, please complete the form included on the back of this sheet and return it with payment by August 1 to Julie Clopton, Director of Transportation, at 222 E. King, Andover, KS 67002.
If you have any questions about Andover Public Schools Transportation or The A-Line, please contact the Transportation Department at (316) 218-4621 or cloptonj@usd385.org.
Application for Busing in the A-Line Program (for students who live less than 2.5 miles from their school) Please complete one form per family per location, listing each child in the household who will be riding the bus.
1. Student’s Last Name:__________________________________ First Name: ______________________________ School: __________________________________ Grade: _________ 2. Student’s Last Name:__________________________________ First Name: ______________________________ School: __________________________________ Grade: _________ 3. Student’s Last Name:__________________________________ First Name: ______________________________ School: __________________________________ Grade: _________ 4. Student’s Last Name:__________________________________ First Name: ______________________________ School: __________________________________ Grade: _________ Home address: ____________________________________________________________________________________ Parent/Guardian Name: ____________________________________________________________________ Cell Phone: ________________ Work Phone: _________________
Evening Phone: __________________
If you qualify for free or reduced lunches, this service is free. Please make checks payable to Andover USD 385.
Enclosed: $______ for #_____ students in family.
If you paid online, please print a copy of your receipt and send it in with this form. Alternate Pick Up and Drop Off Request If a student is to be picked up or dropped off at an address other than the home, fill out the information below. Please note: the location must be in the boundaries of the school the student is attending—student transfers due to babysitter location may be allowed — contact Administration at (316) 218-4660. Pick up location: ____________________________________ _________ Name of resident ___________________________________________________ Address
_______________________ Phone #
Pick up days: M T W TH F
Drop off location: ____________________________________ _________ Name of resident ___________________________________________________ Address
_______________________ Phone #
Pick up days: M T W TH F
***************************************Office Use Only Below*************************************** Date: ____________
Method of Payment: _______________
Amount Received: $_______
Student #1 Bus # ____________
Fee $100 per student per year
Student #2 Bus # ____________
Maximum fee of $150 per year for all students in one family who live at the same address.
Student #3 Bus # ____________
ANDOVER PUBLIC SCHOOLS USD 385
DEPARTMENT OF HEALTH SERVICES MEDICATION ADMINISTRATION RELEASE FORM I hereby certify that _________________________ has previously had at least one dose of the prescribed medication listed and did not have an adverse reaction from it. I request that this medication(s) to be administered at school as prescribed by the physician. I understand that any school employee who administers this prescription to my child in accordance with written instructions from the physician or dentist (and USD #385 Board of Education Policy) shall not be liable for damages as a result of an adverse drug reaction suffered by the pupil, because of administering such a drug or because of a mislabeled or altered product. I hereby authorize USD #385 Department of Health Services personnel to exchange information regarding dispensing and monitoring of this medication with ___________________________, the attending physician or dentist, or with the pharmacy as identified on the label of the prescribed medication container. __________________________________________ Signature of Parent/Legal Guardian __________________________________ Date
________________________________ Telephone
NOTE: The medication is to be brought to school in the original container appropriately labeled by the pharmacy, or physician, stating the name of the medication, the dosage and times to be administered. -------------------------------------------------------------------------------------------------------------------------------
Building: _____________________________Teacher/Grade______________________ Student’s Name____________________________________Birth Date:______________ Medication:_____________________________Diagnosis:________________________ Route:_______________________________Dosage:_____________________________ Special Directions for Administration:_________________________________________ ________________________________________________________________________ Time to administer at school:________________________________________________ Requested starting date of treatment:___________________Duration:_______________ _________________________________________________ Physician’s Signature _____________________________________________________________________________________ Telephone Fax # Date
Prairie Creek PTO Committees 2011-12 Name:_____________________________________________
Phone:_________________________________
Email:______________________________________________
Children's Names and Grades:____________________________________________________________________________________________________________________________________ Following are the committees for the 2011-12 school year. Please select the committees you are willing to be involved in. Return this form with your registration packet. Thank you for your participation and support! Any questions please contact Roxanne Washington: 316-204-6232 or momi_rox@yahoo.com HOME ROOM PARENT As a home room parent you are responsible for planning the spring and fall parties for your child's class and helping with teacher appreciation week in May. o Yes, I would like to be a home room parent for my child's class. o I would like more information about this committee.
HELPING HANDS Helping Hands volunteers greet and direct students to their class, lunch and bus the first few days of school.
GAD PARADE This committee helps design and construct the float for the GAD Parade in the fall. o Yes, I would like to help with this committee. o I would like more information about this committee.
FALL/SPRING FUNDRAISERS This committee helps count money and distribute fundraiser products.
YEARBOOK The Yearbook Committee helps gather pictures for the yearbook. If you are interested in taking pictures at school events, this is the committee for you. o Yes, I would like to help with this committee. o I would like more information about this committee.
BOOK FAIR The Book Fair Committee helps sell books at the spring and fall book fairs, as well as set up and take down. Shifts are approximately two hours. o Yes, I would like to help with this committee. o I would like more information about this committee.
WELCOME WAGON The Welcome Wagon Committee provides food for the Welcome Wagon Coffee at the beginning of the school year. It is a meet and greet event for parents to connect. o Yes, I would like to help with this committee. o I would like more information about this committee.
FAMILY FUN NIGHT The Family Fun Night Committee organizes and runs the school family carnival in the fall. In addition to planning, volunteers are needed to work shifts at the event and bring baked items. o Yes, I would like to help with this committee. o I would like more information about this committee.
CONFERENCE AND HOLIDAY STAFF MEALS Members of this committee will be responsible for sending items to create meals during parent-teacher conferences and winter holidays. o Yes, I would like to help with this committee. o I would like more information about this committee.
STAFF APPRECIATION DAYS This committee will help plan staff appreciation days and teacher appreciation week. If you would like to help plan or simply be willing to help provide food, decorations or gifts, please select this committee. o Yes, I would like to help with this committee. o I would like more information about this committee.
MUSIC PROGRAMS The music program committee will help decorate for music programs. Volunteers are also needed to help with rehearsals and program nights. o Yes, I would like to help with this committee. o I would like more information about this committee.
ART SHOW The Art Show Committee helps organize and hand artwork for the Spring Art Fair. o Yes, I would like to help with this committee. o I would like more information about this committee.
PICTURE DAY COORDINATORS Volunteers are needed to assist children before pictures in the fall and spring. o Yes, I would like to help with this committee. o I would like more information about this committee.
OFFICE HELPERS Office helpers assist with copying, laminating and separating for Friday folders. Volunteers are needed for Friday mornings. o Yes, I would like to help with this committee. o I would like more information about this committee.
HOLIDAY CARING AND SHARING This committee is responsible for the holiday food drive. Volunteers are needed to help deliver food and products to the Andover Food Bank. o Yes, I would like to help with this committee. o I would like more information about this committee.
PANTHER PROWL The Panther Prowl Committee organizes and runs our Panther Prowl walk-a-thon fundraiser. Volunteers are also needed to help at the event. o Yes, I would like to help with this committee. o I would like more information about this committee.
READING LAB/LIBRARIAN HELPER Reading Lab volunteers help with Read Across America and Dr. Suess Day. Volunteers to help our librarian check in and reshelve books are also needed. o Yes, I would like to help with this committee. o I would like more information about this committee.
GENERAL VOLUNTEER Please check here if we may call on you for any committees or activities that may need additional help.
If you have a specialized skill or profession that would allow you to volunteer in a unique way, we would love to know. We welcome your comments and suggestions as well. _________________________________________________________ _________________________________________________________ _________________________________________________________
o o
o o
o
Yes, I would like to help with this committee. I would like more information about this committee.
Yes, I would like to help with this committee. I would like more information about this committee.
Yes, you may contact me as needed.
BOX TOPS/ TYSON/ CAMPBELLS COMMITTEE The Box Top Committee is responsible for collecting and submitting Box Tops, Tyson A+ labels and related programs. They also determine the prizes for the classes who return the most labels. o Yes, I would like to help with this committee. o I would lke more information about this committee. T-SHIRTS The T-Shirt Committee is responsible for creating, ordering and selling Prairie Creek apparel. o Yes, I would like to help with this committee. o I would like more information about this committee.
Prairie Creek Elementary Volunteer and Confidentiality Guidelines Volunteers: We deeply appreciate your support and presence at our school. Our partnership is critical to the success of our students. Please know how much your assistance is appreciated. While at school, we ask that you adhere to the following expectations. All volunteers are asked to read the information below and complete this form prior to providing volunteer services at our school. CONFIDENTIALITY NOTICE: Information you witness or hear while observing may be confidential or privileged and is not to be shared or discussed with ANY individuals other than staff members. Furthermore, student names and behaviors should not be discussed with anyone other than the staff member(s) in charge of the area you are providing assistance in.
BUILDING CODE OF ETHICS (FOR VOLUNTEERS) 1. Respect the confidentiality of the teacher and the students, and refrain from discussing confidential issues outside the school setting. 2. Respect the teaching/learning process by arranging to discuss your child’s progress at other times than when you are volunteering. 3. Maintain a strong relationship of trust, integrity, and respect with adults and children. 4. Be dependable. If you are unable to fulfill your scheduled volunteer time slot, please call the office so that we can notify the teacher and they can make other arrangements.
By signing, I hereby agree to these terms and conditions. Print Name: ___________________________________________ Signature: _____________________________________________ Date: _____________________________
Please return this completed form to the school office. Thank you!
The following pages only apply to students new to Andover Public Schools.
PRAIRIE CREEK ELEMENTARY New Student Placement Information Form 2011-2012 School Year
Student Name: ______________________________________
Male or Female (Please circle)
To better help us place your student, please provide the following information: 1. Was your child ever retained? If so, which grade(s)?
2. How was your child performing academically at his/her previous school?
3. Was your child involved in any special programs and what were they? (Example: Title I reading and math programs, speech, language, learning disabilities, special classroom placement, gifted, enrichment, etc.)
4. Please describe your child’s personality. (Is he/she excitable, creative, very active, quiet, etc.)
5. Would you say your child would benefit from (please circle): a. A structured classroom b. A Flexible classroom c. Either type of classroom
Please use the back of this form to add any additional information about your child that would help with your child’s placement. Thank you.
Parent/Guardian Signature
Date
S:\PCES\Office\School\Forms\New Student Placement Form.docx
Prairie Creek Elementary School 654 YMCA Drive; Andover, KS 67002 Shelley Jonas, Principal 316-218-4830 Office 316-733-3651 Fax REQUEST FOR TRANSCRIPT
Date Student
Grade
Registrar: Please send us at your earliest convenience, all official records, transcript of grades, cumulative records, test results, health records, athletic eligibility, and any other data directly related to this student. Please include the following special education records if these apply to the student: 1) Individualized Educational Plan (IEP), 2) placement Statement, 3) latest evaluation or reevaluation report, and 4) psychologist’s report.
Former School:
Send Records To:
Prairie Creek Elementary 654 YMCA Dr Andover, KS 67002 Attn: Registrar
Parental permission is no longer required when records are requested by authorized school personnel. (Family Education Rights and Privacy Act, Final Rule on Education Records, Federal Register, June 17, 1976, Vol. 41, No. 118, page 24673.)
S:\PCES\Office\School\Forms\Request for Transcript.docx Revised 8/5/09
ANDOVER USD #385 PROOF OF RESIDENCE This form must be accompanied by a verification of residency. Acceptable forms of verification are: Utility Bills, Lease Agreement or Homeowner Contract.
Date: ___________________
School: ______________________________
Student(s) Name(s):
Grade:
___________________________________
________________
___________________________________
________________
___________________________________
________________
___________________________________
________________
I, _________________________, the parent/guardian, declare that the above students reside with me at the following address: Street Address: ______________________________________________________ City: __________________________________ Zip: _______________________ I understand that the accuracy of the above information is important to the continued enrollment of my child(ren).
Parent/Guardian Signature: ____________________________________________
ANDOVER PUBLIC SCHOOLS USD 385
HEALTH EXAMINATION REPORT Pupil’s Name_____________________________________ SS#__________________ Birth Date_____________ Grade___________ Last First To Parents: For maximum health your child should have a periodic health Immunization – Please attach green Kansas examination. If your child is entering Kindergarten (or is new to Kansas Certificate of Immunization (KCI) with all dates Schools and is under 9 years of age) please obtain an examination of for DPT, Polio, MMR, Varicella, and Hepatitis B your child by your family doctor. Gender: M______F_______ recorded - with Physician Signature and Date. Height_____ Weight_____ BP_____ T_____ P_____ R_____ Central Nervous System________________________________________ Epilepsy?__________ Emotional Disturbance?______________ Cardio-Vascular System________________________________________ Optional other vaccines or tests:____________________ Heart Disease?____________________ Limitation?__________ Yes No EENT (Eye, Ear, Nose & Throat)_________________________________ Are routine medications prescribed? Myringotomy?____________________ Glasses?____________ Endocrine System_____________________________________________ NOTE: If medication is to be given at school, please Diabetes Mellitus?_____________________________________ provide written physician/parental request. Gastrointestinal System________________________________________ Nutritional Status______________________________________ Physical Education: Genitourinary System__________________________________________ Regular_______________________________________ Musculo-Skeletal System_______________________________________ Limited (explain)_______________________________ Scoliosis?____________________ Arthritis?________________ None (explain)_________________________________ Respiratory System____________________________________________ Date__________________________________________ Asthma?_____________________ Allergies?_______________ Social Development (family, peer, school if appropriate)______________ Recommendations:____________________________________________ MAY USE BACK OF CARD FOR ADDITIONAL SPACE Physician’s Signature___________________________Date____________
USD 385 DEPARTMENT OF HEALTH SERVICES ANDOVER, KANSAS IMMUNIZATION STATEMENT Please sign and return with enrollment forms.
Name of Student: _________________________________________ Date of Birth: _____________________________________________ I have been notified that Kansas Law (K.S.A. 72-5208, 72-5209, 725210, 72-5211 and 72-5211a) requires every pupil enrolling in any school for the first time, prior to admission, to present proof from a physician or local health department that the pupil has received such tests and inoculations as are deemed necessary. In USD 385, proof of each inoculation received must be presented prior to admission. Also, mandatory booster inoculations in all required series must be received (within 30 days for students admitted after September 1). If transferring into USD #385, it is the parents obligation to make sure proof of inoculations are received within 30 days. Required inoculations include the following: DTP, DTaP and/or DT/Td OPV or IPV MMR Hepatitis B Varicella
Additions for Early Childhood Hib PCV7 (pneumococcal) Hepatitis A
Parents will be notified of any additional requirements. Parent/Guardian Signature Indicating Receipt of Notice: _______________________________________Date:_________________ Student is transferring from: _____________________________________ Name of School
Date Student Entered USD #385:
City
St.
_______________________________
KANSAS CERTIFICATE OF IMMUNIZATIONS (KCI) This record is part of the student's permanent record and shall be transferred from one school to another as defined in Section 72-5209 (d) of the Kansas School Immunization Law (amended 1994.)
Student Name:
Address:
Parent or Guardian Name: Phone: Birthdate (MM/DD/YYYY):
1st
2nd
3rd
4th
5th
7th
State Type
If additional doses are added, please initial the dose and sign below:
Required for school entry.
HEP B
(Hepatitis B) Required for school entry through Grade 10 for 20102011 school year. Recommended for all children.
Varicella
Hx of Disease: Physician Signature:
(Chickenpox) Required for school entry through Grade 10 for 2010-2011 school year. Recommended for all children.
MMR
6th
(Diphtheria, Tetanus, Pertussis) Required for
school entry.
Polio
County
RECORD THE MONTH, DAY, AND YEAR THAT EACH DOSE OF VACCINE WAS RECEIVED
VACCINE DTaP/DT/Td/Tdap
Ethnicity:
Race:
SEX: [ ] MALE [ ] FEMALE
(Measles, Mumps, and Rubella combined) Required for school entry.
Influenza (Flu) Recommended annually for ages 6mo - 18 yrs. Not required for school entry.
HIB
(Haemophilus Influenzae Type B) Required < 5 years of age for preschool or child care operated by a school.
PCV7
(Pneumococcal Conjugate) Required < 5 years of age for preschool or child care operated by a school.
HEP A
(Hepatitis A) Required < 5 years of age for preschool or child care operated by a school.
MCV4
(Meningococcal) Recommended at 11 years of age. Not required for
school entry.
HPV
(Human Papillomavirus) Recommended for females and provisionally recommended for males at 11 years of age. Not required for school entry.
Rotavirus
Recommended < 8 mo. Not required for school entry.
DOCUMENTATION
LEGAL ALTERNATIVES TO VACCINATION REQUIREMENTS "KSA 72-5209"
KCI MAY ONLY BE SIGNED BY A PHYSICIAN (MD/DO), HEALTH DEPT, OR SCHOOL.
q
I certify I reviewed this student's vaccination record and transcribed it accurately.
Agency Name: Authorized Representative: Address: The record presented was:
q q
Kansas Immunization Record
1. "Annual written statement signed by a licensed physician (Medical Doctor/M.D. or Doctor of Osteopathy/D.O.) stating the physical condition of the child to be such that the tests or inoculations would seriously endanger the life or health of the child." Medical exemption shall be validated annually by physician completion of KCI Form B and attachment to the KCI. KCI FORM B - MEDICAL EXEMPTION is located at http://www.kdheks.gov/immunize/imm_manual_pdf/KCI_formB.pdf
Date:
2. "Written statement signed by one parent or guardian that the child is an adherent of a religious denomination whose religious teachings are opposed to such tests or inoculations."
Other Immunization Record (Specify)
KANSAS IMMUNIZATION PROGRAM 1000 SW Jackson, Suite 210, Topeka, KS 66612-1274 PHONE 785-296-5591 FAX 785-296-6510 WEB SITE www.kdheks.gov/immunize
I give my consent for information contained on this form to be released to the Kansas Immunization Program for the purpose of assessment and reporting.
Parent/Legal Guardian's Signature
Date
Rev. 02/01/2010
KANSAS IMMUNIZATION REQUIREMENTS: Based on age of child as of September 1 of current school year. As per Kansas Statute 72-5209, all children upon entry to school must be appropriately vaccinated. In each column below, vaccines are required for all ages listed in that column. Ages 0-4 Recommended Schedule
Birth
HEP B
2 Months
DTaP/DT POLIO HEP B HIB PCV7 ROTAVIRUS
4 Months
DTaP/DT POLIO HIB PCV7 ROTAVIRUS
6 Months
12-15 Months
DTaP/DT POLIO HEP B HIB PCV7 ROTAVIRUS DTaP/DT MMR VAR HIB PCV7 HEP A
Recommendations are based on the ACIP recommended schedule.†
Ages 5-6 DTaP/*DT: 5 doses
a) 4 week minimum interval between doses, with at least 6 months between dose 3 and dose 4. b) 4 doses acceptable if dose 4 given on or after the 4th birthday. c) If dose 4 is administered before the 4th birthday, a 5th dose must be given at 4-6 years of age. * If 1st DT dose given at <12 months of age, 4 doses recommended; acceptable only when Pertussis component is contraindicated by the physician. * If 1st DT dose given at 12 months or older, 3 doses complete primary series; acceptable only when Pertussis component is contraindicated by the physician. The limit for DTaP vaccine is 6 doses, regardless of schedule. POLIO: 4 doses of POLIO are acceptable IF:
a) 4 week minimum interval between doses, regardless of age given. 3 doses of POLIO (all IPV) are acceptable IF:
a) 4 week minimum interval between each dose, with 1 dose given on or after the 4th birthday. The limit for POLIO vaccine is 5 doses, regardless of schedule. MMR: 2 doses
Ages 7 and Older Tdap/Td: 3 doses if DTaP/DT series not completed previously† One of the doses must be Tdap if student is without a Pertussis medical exemption.
a) 4 week minimum interval between dose 1 and dose 2. b) 6 month interval between dose 2 and dose 3. Booster dose of Tdap is required at 7th grade if more than 2 yrs since previous dose of Td. Tdap booster required 10 years after the completion of the primary series or previous dose. Only one dose of Tdap is needed during adolescence. KCI Form B Medical Exemption should be completed by a physician if pertussis is contraindicated. POLIO - All IPV or OPV Schedule 4 doses of POLIO are acceptable IF:
a) 4 week minimum interval between doses, regardless of age given. 3 doses of POLIO are acceptable IF:
a) 4 week minimum interval between each dose, with 1 dose given on or after the 4th birthday. POLIO - IPV/OPV Combination Schedule 4 doses of POLIO are acceptable IF:
a) 4 week minimum interval between each dose, regardless of age given. Three doses of a combination schedule are NOT acceptable. The limit for POLIO vaccine is 5 doses, regardless of schedule.
a) First dose must be on or after the 1st birthday. b) 4 week minimum interval between doses. Single antigen measles vaccine will not meet requirements without the addition of mumps and rubella vaccine. VARICELLA: 2 doses required for Kindergarten and Grade 1 for 2010-11 school year; 1 dose required for Grades 2-10 for 2010-11 school year
a) b) c)
First dose must be on or after the 1st birthday. None required if prior varicella disease verified. Two doses are recommended for all children.
HEPATITIS B: 3 doses required through Grade 10 for 2010-11 school year
a) b) c) d)
4 week minimum interval between dose 1 and dose 2. 8 week minimum interval between dose 2 and dose 3. 16 week minimum interval between dose 1 and dose 3. Dose 3 must be given after 24 wks of age.
MMR: 2 doses
a) First dose must be on or after the 1st birthday. b) 4 week minimum interval between doses.
VARICELLA: 1 dose required through Grade 10 for 2010-11 school year
a) First dose must be on or after the 1st birthday. b) None required if prior varicella disease verified. c) Two doses are recommended for all children. HEPATITIS B: 3 doses required through Grade 10 for 2010-11 school year a) 4 week minimum interval between dose 1 and dose 2. b) 8 week minimum interval between dose 2 and dose 3. c) 16 week minimum interval between dose 1 and dose 3. d) Dose 3 must be given after 24 wks of age.
† - The ACIP Schedules may be accessed at: http://www.cdc.gov/vaccines/recs/schedules Vaccine doses given up to 4 days before the minimum interval or age may be considered valid. With the exception of Hepatitis B vaccine, immunizations given before 6 weeks of age are not considered valid. Half doses or reduced doses of vaccine are not considered valid.
PARENTS AND/OR GUARDIANS ARE NOT AUTHORIZED TO COMPLETE KCI FORMS. KCI FORM B - MEDICAL EXEMPTION is located at http://www.kdheks.gov/immunize/imm_manual_pdf/KCI_formB.pdf BLANK VERSION OF KCI FORM is available at http://www.kdheks.gov/immunize/download/KCI_Form.pdf A ROSTER WITH THE NAMES OF ALL EXEMPT STUDENTS SHOULD BE MAINTAINED. PARENTS OR GUARDIANS OF EXEMPT CHILDREN SHOULD BE INFORMED THAT THEIR CHILDREN SHALL BE EXCLUDED FROM SCHOOL IN THE EVENT OF AN OUTBREAK OR SUSPECTED CASE OF A VACCINE-PREVENTABLE DISEASE.