03/18/04

 

Dear Parents/Guardian:

 

The Wisconsin Student Immunization Law now requires proof of varicella (chickenpox) immunity in certain grades in school.  The requirement is being phased-in as follows:

 

2004 - 2005 School Year = Grades K- 8                 2005 – 2006 School Year = Grades K-12

 

Many students are already immune by virtue of having the chickenpox disease when they were younger.  In order to determine who had the chickenpox disease or who may already have received the varicella vaccine, please complete the questions below and return this form to your child’s school.

 

This notice should give you ample time to have your child/children vaccinated before the start of school in September 2004.  If your child needs the varicella vaccination you can make an appointment with the Oneida County Health Department or with your child’s physician. 

 

A child is considered compliant with the law if either a vaccination date is provided or an indication that the child had the chickenpox disease.  Waivers are available for medical, religious or personal conviction reasons.  You may request a waiver form from Kerri Schmidt, Rhinelander School District Nurse. 

 

Your cooperation in this matter is greatly appreciated,

 

Kerri R.Schmidt, BSN, RN, CCM                     

Rhinelander School District

 365-9235                               

 

Linda Conlon, Director/Health Officer

Oneida County Health Dept.                                                                                             

 365-6111

 

TO BE COMPLETED BY PARENT/GUARDIAN
Name:        Last                                First	DOB:	School:		Grade:
o      My child had the chickenpox disease.  What year, if known?  __________________________________   o      My child had the varicella vaccine on the following date(s).   _____/_____/_____           ____/_____/_____   Please note:  For children 12 months – 12 years, one dose of varicella is required.  For children 13 years and older, 2 doses are required at least 4 weeks apart.
SIGNATURE OF PARENT/GUARDIAN:			DATE:

       Please Read the Chickenpox Vaccination Information Sheet before you sign the document. You can view the Chickenpox Vaccine Information sheet at National Immunization Program's Website @ http:/www.cdc.gov/nip