Medical Requirements Checklist

Department:  Superintendent's Office  
Type:  Health Form  

Weston Public Schools

(For Kindergarten and all new students entering the Weston Public Schools)
Immunization Requirements
(in English and signed by the Health Care provider)
5 doses of DTP (Diphtheria Tetanus, Pertussis)
4 doses of IPV or OPV (Polio)
3 doses of Hepatitis B
2 doses of MMR (Measles, Mumps, Rubella)
2 doses of Varicella (Chicken Pox vaccine) OR
certified reliable history of Chicken Pox disease
1 Tdap booster (Tetanus, Diphtheria, Pertussis)
(*required all students entering Grades 7-12)
Stereopsis Eye Screening (Kindergarten entry only)
Lead Screening Test (Kindergarten entry only)
____Health Care Provider Exam & Immunizations
Your child’s physical exam must include up to date immunizations. The Health Care
Provider’s signature and date must be clearly written. (Exam must be within 12 months
preceding date of entry.)
____Annual Nurse Emergency Form
Please complete both sides of this form. It must be signed and dated by parent/guardian.
This form is available to download; details below.
Note: Download the Health Care Provider’s Examination and  Certificate of Immunization  if your physician does not use standard forms.
Students wishing to participate in Middle School or High School sports must contact the
Athletic Director (Phone: 781-786-5840).

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