Student Name------------------------------------------

The following must be complete before we can accept your enrollment packet:

_Complete Enrollment Packet

_Proof of Residency

_Birth Certificate

_Proof of Guardianship if applicable

_Immunization Records

_IEP or 504 Documentation if applicable

_Transcript request forms (from all schools attended where High School credits were earned)

**Bayfield High School will not accept incomplete enrollment packets. Students will not beregistered for courses without a complete packet.

BHSStaff accepting enrollment packet. _ Date-----------

BAYFIELD HIGH SCHOOLENROLLMENT PACKET

2016-2017

***PLEASE PRINT CLEARLY ON ALL FORMS. PLEASE ENSURE ACCURACY ON ALL FORMS. INACCURANCIES MAYLEAD TO A DELAY IN ENROLLMENT.

STUDENTNAME: _

PARENTS/GUARDIAN NAME: _

We require proof of current phYSical address. One of the following will be sufficient.• Proof of Home Purchase• Utility Bill• lease Agreement• Rental Agreement

Weighted grades will not be accepted from transferring schools unless the equivalent course is offered atBayfield High School for a weighted grade.

Parent Signature: _Date: _

RECORDS RELEASE FORMAUTHORIZATION TO RELEASESTUDENT INFORMATION AS PERH.R. 69, PUBLICLAW 92-380, SEC.433 OF THE UNITEDSTATESCODE "PROTECTIONOF THE RIGHTSAND PRIVACYOF PARENTSAND STUDENTS."

Please mail records to: Student RecordsBayfield High School

Address: SOO County Road 501Bayfield, CO 81122

Phone: (970) 884·9521Fax: (970) 884-4226

AUTHORIZATION TO RELEASESTUDENTINFORMATION

Registrar or Counselor:

You are hereby authorized to release from your records the following data concerning the student listed below:i) OffiCial Transcript2) Withdrawal Grades3) Standardlled Test Data4) Immunizations/Medical Oat.,5) Special Education IEP Records6) Birth Certificate

Name and address of school from which student's records are requested:

Previous School Name Student Name

Street Address Current Student Grade

Post Office Box Parent/Guardian Signature

City State Zip

Phone Number 1stNotice Sent

Fax Number 2M Notice Sent

BAYFIELD SCHOOL DISTRICT 10JT-RCONFIDENTIAL INFORMATION FOR CUMULATIVE RECORDS

Failure to provide accurate and complete Information may result In delayed or terminated enrollment. Exception; If you arecurrently in the process of purchasing or renting a home in our district, a 30 day grace period may be provided to attain proof ofresidency. This form Is to be filled out by parent or guardian only. Please fill In all Information on this form. All Information will bekept strictly confidential. Student may start school 24 hours after paperwork Is returned.

Today's Date __ Date Student will start school Enrollment Grade __

Has your student ever attended Bayfield School District? 0Yes 0No If so, what was most recent year? _

What is the most recent date your student enrolled In a Colorado school?

Last Name _ First Name Middle Name _

Physical Address City, State, Zip

Mailing Address City, State, Zip

Home Phone Cell Phone ___ Student's Cell Phone _

Parent Email Address _ ~__ _ Birth Date

D Male D Female

Ethnlclty: Do you consider your student to be of Hispanic or Latino origin? 0Yes 0No

Race: Which of the following groups describe your student's race? You may select more than one.

o White- A person hailing origins in any of the original peoples of Europe, the Middle East, or North Africa.o Black or African Amerlcan- A person having origins In any of the black racial groups of Africa.o Aslan- A person having origins In any of the original peoples of the Far East, SOutheast ASia, or the Indiansubcontinent including. for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan. the PhilippineIslands, Thailand and Vietnam.o American Indian or Alaska Native- A person having Origins in any of the original peoples of North America and SOuthAmerica (including Central America), and who maintains tribal affiliation or community attachment.o Native Hawaiian/Other Pac Islander- A person having origins in any of the original peoples of HawaII, Guam, Samoa,or other Pacific Islands.

Father's NameEmployer

Home PhoneWork Phone

Cell PhoneC 'Ii Phone

Mother's NameEmployer

Home PhoneWork Phone

Cell PhoneCell Phone

Student lives wlth:O Father 0 Mother 0 Stepfather oStepmother 0 Guardian DOtl1er

Guardian's Name _Employer __

Home PhoneWork Phone

(Ollef, plelse)

Cell PhoneCell Phone

Step Father's NameEmployer

Home PhoneWork phone

Cell phoneCell Phone

Step Mother's Name _Employer

Home PhoneWork Phone

Cell PhoneCell Phone

Emergency Contact Name #1 _Relationship Phone Cell Phone

Emergency Contact Name 112Relationship ___ Phone ___ Cell Phone

Is there a second mailing address you would like correspondence sent to? (This would be report cards, newsletters, etc. that aparent would like to receive who does not Ilve with this student.)

NameOW _

Address_____ State Zip Phone

ISyour student currently receiving support services? 0School Counselor DGlfted Education Serviceso PLS04 Education 0 Title I ReadingOSpeech

Has your student received special education services in the past? 0 Yes 0 NoIf your student was in SpeCial Education last year, what was the primary disability? __Within the last calendar year, has your student been expelled for any reason? 0 Yes0 NoIs your student In the process of beinglnllestlgated for a possible expulsion? DYes 0NoFirst date your student enrolled in any school in the U.S. _______j____j _

Month Day year

What school/district did your student attend In March of last vear?School District

2 years ago?School District

3 years ago7School District

Please list siblings and their blrthdates:First Middle Last Date of Birth

First Middle last Date of Birth

First Middle Last Date of Birth

First Middle Last Date of Birth

First Middle last Date of Birth

Is there anyone that your student MAY NOT be released to? If this Is a custody Issue and there are restralnins orders, we ~have <IcOPV ofthe restra Inlng order

Parent/Guardian Signature _

Bayfield School District24 Clover Drive Bayfield, Colorado 81122

970-884-2496Home Language Survey

Parent(s) or Guardian(s):Please answer the questions below accurately and completely. This infonnation is necessary to provide themost appropriate placement and instruction for you child and will not be used for any other purposes. Thankyou for your cooperation.

Student Name: Date:

Date of Birth: Grade:

Parent Name: Parent Phone Number:

1. Does the student speak a language other than English? (Do not include Yes Nolanguages leamed in foreign language classes.)

2. Does the student understand a language other than English? (Do not Yes Noinclude languages leamed in foreign language classes.)

3. Does anyone in the student's home speak a language other than English? Yes No(Including parents, guardians, babYSitter, siblings or grandparents)

Stop here and sign below if the answer to questions 1 through 3 above are "no". If any of theanswers to questions 1 through 3 above are "yes", sign below and complete the followingquestions.

Date Signature of Parent or Guardian: _

Student Place of Birth: Student entry date In U.S. SchOOl:

What language did your child first learn to What language does your child use mostspeak? often at home?

What language do you most often use to What is the first language of each parent?speak to your child?

Has the student been in a bilingual or an ESUELL program? Yes No

Did the student exit the program? Exit date: Yes No

BAYFIELD SCHOOLS HEALTH QUESTIONNAIREGrad •• K·12

Student's Name Date of Birth

Please circle each appropriate answer:

Has your student ever been treated for any vision problems?If yes, please explain:

Hal your student ever been treated for any hearing problems?If yes, please eleptaln: _

D08s your 8tudent have any speech problems?If yes, please explain:

Yea No

Ves No

Ves No----- -----

Doe8your student have any restrictions on what they can orcan't eat? If yes, pleas. explain:

Does your student have any dlsabUitles or restrictions onphysical activities? If yea, plea,. explain:

Ve. No

Ves No

Is your student allergic to anything (food, medication,Insect blt.s)? If yes, please explain:

Does your student have any chronic health problems such asasthma, seizures. diabetes, etc.? If yes, please explain:

Vea No

Ves No

Is your student currently taking any medications?If yes, what medications and what for:

Yes No

Has your student had any serious IUnass,accidents or surgeries?If yes, plesse explain: __

Yes No

I. there anything else about your student's health that you think IsImportant for the school to know?

Parent/Guardian Signature _ _ Date _

PLEASE COMPLETE THE OTHER SIDEIF APPROPRIATE

By law, prescription medications cannot be given at school without a written prescriptionfrom the physician and a signed consent by the parent or guardian. The prescription must be Inthe original bottle. PrescrlptJon medication mUlt b brought to school In a containerappropriately labeled by the pharmacy or physician .tallng the .tudent', n me, the n me of themedication, dosage and frequency. Over the counter medlcln , by district policy, al'o n ed, awritten prescription from a doctor and a signed con ant by • P rent or guardian. The m dlc tionmust be In the original boWe. Parents may come to school to dmlnl ter medications to theirstudent. Students are not allowed to carry any medication, prescription or over the counter, ontheir person without written permiSSion 'rom a physician and a parent All medications should bebrought to the health office. Your student IIresponsible for coming to the Office to receive theirmedication.

IF YOUR STUDENT HAS ASTHMA, PLEASE COMPLETE THE FOLLOWING:

Student Name

When was your student's last asthma attack?

How often does your student have an acute episode?

Does your student do breathing eKerclses that are helpful In managing their asthma?

Does exercise Induce episodes of asthma? Yes_ No_ If yes, ptease list types of exercise:

00 certain weather conditions affect your student" asthma? Yes_ No_ If yes, whichconditions?

Should medication be kept at school? Yes_ No_ If yea, please bring the medication with adoctor's prescription to the office. Parent permission Is also required.

Does your student suffer any side affects from this medication? Yes_ No_If yes, please list:

Doe8 your student understand asthma and what they should do to manage their asthma?

How do you want the school to treat an episode If It should occur? _

If your student doe. not respond to the medication, what action do you advise the school to take?

Comments:

---------Parent/Guardian Signature Date

STUDENT ACCEPTABLEUSE AGREEMENT

Bayfield School District

Electronic information resources are available to qua/~fying students in the BayfieldSchool District. These resources include the use of the computer and access to the localarea network, and Internet services. Our district goal, in providing electronic services tostudents, is to promote educational excellence by facilitating resource use, innovation,communication and acceptable use. The Bayfield School District Internet system is beingfiltered by a pro"y server. Student use of the Internet is monitored. Students who abuseacceptable use, which includes, but is not limited to: copyrighted material, threatening orobscene material, pornography, gambling, and inappropriate language will be subject todiscipline.

To qualify for electronic information resource services, students must be willing to abideby the rules of acceptable use. It's important for parents to help elementary school agechildren understand and abide by these simple but important rules of appropriate use.

Student Acceptable Use:Acceptable use means Ihat as a student in Bayfield School District, you will promise touse the computer and those special learning tools and programs. such as the Internet, withrespect. Acceptable use means you will promise to abide by the school and district rulesas outlined here and as will be taught to you by your teachers and computer specialists inyour own classroom or school. You must understand that the use of these electronicteaching and learning tools are designed to support your education. If rules are broken, astudent may lose his/her privilege in using the computer and the Internet. Please payspecial attention to the following:

Be Polite and Sbow Respect: When using the computer to write, send or to receivemessages or information, always use kind and proper language and abide by the rules offriendliness. Treat others and equipment with respect. You may be alone in your use ofthe computer, but, what you write or receive, using electronic machines, may be viewedby others with or without your knowledge.You must not vandalize or abuse theequipment. Show respect for property, others and self. The computer and electronicresources belong to the school district.

Be Honest and Obey the Rules: Do not do things on the computer that would beagainst the rules. the law, or may be looked upon as dishonest. Use the computer andthe Internet for appropriate educational purposes only.

Keep Personal Things Private: It is advised that students not tell or show others anypersonal or family information over the Internet, such as: home address. phone numbers,passwords, personal photos when used with names, or Social Security numbers. Donot log on or use another person's account. Keep personal and electronic informationprivate.

My Promise to Follow tbe Rules:My parent or guardian has reviewed the Bayfield School District Acceptable UseAgreement with me. Iunderstand the importance of being polite, respectful, honest, andthe need to obey the rules for the use of the computer and the Internet. Ialso know Ishould not give out personal information about myself or my family over the Internet. Iunderstand that the computer. the Internet and other electronic information resources areto be used for educational purposes. I also understand that if I break the rules, my use ofthese educational tools may be taken away from me and that other disciplinary or legalaction may be taken. I promise to follow the rules.

Student Name (please print):

School: Grade: Teacher:

Student Signature: Date:

Parent or Legal Guardian:As the parent or legal guardian. Ihave read and Ihave reviewed with mystudent. the Bayfield School District Acceptable Use Agreement. J understandthat the use of these electronic information resources is for educational purposes. Irecognize the District has initiated reasonable safeguards to filler and monitorinappropriate materials. I understand that while the District has also taken steps to restrictstudent access on the Internet to inappropriate information and sites, it is impossible torestrict access to all controversial materials. I further recognize that if my child does notabide by the rules of acceptable use, he/she may be disciplined. Iwill not hold theBayfield School District responsible for materials my child may acquire on the Internet. Ihereby give permission to the Bayfield School District to permit my child to have accessto the Local and Wide Area Networks and the Internet.

Parent or Legal Guardian (please print):

Address: City: Zip:

Telephone: E-Mail:

Signature: Date'

ANNUAL NOTIFICATION UNDER 34 CFR §300.1S4(d)(l)(v)

Tho re,ulatlons imp tin, tho Indivldualt With OiJabllif Edu lion Act (IDEA). alford p u ofoliJiblo students c:ena.ln ri&btl wi1tl poet to • school dl 'ct'sibilily to. priv inlUran orpublic benefits. .uch u MediuMS, to h Ip ply for certain ...-vic thlt arc provided at lChool. Thrisflts are u follows:

I. YOU/£f JIB THB VGHT ro UCllIYB NOTICE IN AN UNDBItST..tNDA6ULANGUAGE. Tho IChool district must live you an annual written notice ofyow' rishtJ. which mull bewritten In lana un dablo to tho amenl public; and abo provldoci in tIM nativo Ian of theparent or other modo of communication UJOdby the parent, unl it is clearly not fl ib to do 10.

2. YOU, CHILD'S CONFIDBNTIAL INFOWATION CANNOT 6B DISCLOSe WlTHomrou, CONSENT. Parental COftIICIlt must be obralood unci. tho Family Educational Rip and PrivlCYAct (PERPA) replalio at 34 CPR par199 and tho IDBA II . at 1300.622 b fore tho IChooIdlltrlct dlIClOi for clalminl PurpotU, your child', penonally idenliflab information to the a ncy

pcwiblo (or the adminiltradon of the SW '. public benefi or i uranoo prosrwn (0·1·, Modicaid);

3. YOU" CHILDHAS A VGHT TO SPBClAL EDUCATION AND .l.BUfED SDVICBSAT NOcoaT TO YOu. Th1I moms that. with reprd 10 lOrYieel required to provide. Free Appropriate PublicEducation ("F APE,,) to an ellaible child under IDBA. the school diJtrict

• May not require parenti to .fp up lor or onroll in public beMftti or inlUl'BllCOproplDllin order for their child to receive FAPE;

• May not require perontl to incur an out-of..pocket 0lqMIII0 IUOb u ••••.payment of adeductible or co-pt)' amount incurrod in filiag • claim for Mn'ices provided puIIUIIlt toChi, pert. but may pay tho COlt chat tho parenti otherwilo would be roqulnMl to pay;

• May not UIO a cbUcr. benefits under & public benefits or lnauranoe propam if that UIO

would:o Docreuo avail.ble IIfeti covcnae or MYother illlUred benefit;o ult in the rlmily payina for lIrVieeI dW would othorwiIe be covered by tho

publio beneft or iDlW'lllOOpropam ad that IN required for tho ohild 0UIIid0 ofthe time the child ia in tdlool;

o IDcreuo premiums or lad (0 tile dilcoGtiDultioa ofbeaefdl or iD.uranoo; oro Riak 10&1of ,ligiblUty for homo ud comm.Wlity-bued Wliven. baed on

agrepte healtb-rolated expeaditurel.

4. YOUMA r 1f1177IDIlAW CONSBNT AT ANY TIMB. Once you'YO siven couent for dilclOlutO ofconfidential inform lion about your child to the ~ I'eIpOIlIiblo for thelldminiltrltioa ordle State'.public benefits or iosuruc:o propam (o.g., Medicaid), you have a 10811rtpt under tho FBRPAregulations to withdraw that co wh vcr you wlsb.

S. IF YOUUFUSB CONSBNT. 0 •. WlTHD~W CONSBNT. 17IE SCHOOL DISTVCT STlUHAS TOI"OVIDElt.BQUIUDSDV1CBSATNO COST TO YOu. ltyou re toprovid confor th dilOlOIUN ofpenonaUy . tiftablo information to lbo c:y po ible for th adminilltntionoftbe State', public fits or lalUrlnCl proaram (e.g., Medicaid), or, If you give con t but then laterwithdraw cons t, that does not relieve tho IChooI district of ill poruibllity to ensure tha.t all requiredlIItVicoIue provided at no coat to the parenti.

eou.tTo ••••• =-;__~4

BeyleldMeoi DWr1d-MdlCAJD JWMIIUUIM&NT-

-St.cs.t HaM: StudMtm:

0.••0'•••.•: Beltool N••• :

ReqUII:Tho DlIcrlct •• your couent to discloN infonnldoa ocmcemln&your child wilen 1IIP1y1n&to Medaicl tbr relmbwMmeot of coveredhtllth ••.•1Dd _ment and/or IEP serv1c:e com. Thil Infonnalion would Iacludc _Ie pItIOIIllly-ldentifylq data, • well asdocw'nan1ltion of yo•• child', dillbility or reuortI for luapeotin& • diJabillty, and determlnIIion of ___ Db aDd lOt IIMcoI1UIOded.Under the Flmlly Educllion R.l&hllllld PrIvacy Act (FBRPA),1UCb Informldon CIft be dllCloIecI only with pantII 00nMftt.

Byaivlna conMnt, you will help the Diltrtct provide ldditlOlllI hoaIlh rclatod ICI'YIcelIOall,tudenll.

",~a:

• The Diltric:t wW not requlN you 10enroll in Medicaid in order for your dtUd to recolve apecll1 ccIucation .mea.• Tho DiIcrIct wlll DOl """IN )'OU to Incur out.of-pocbt oXflOUOl Incurnd In fill.,. • clabn for~. 'l11li Diatricc ~ pay tho

cOlt that you would otherwi •• be required to pc)'.

• T'be Dillric:t will not UN Medicaid Iftblt UII would: (I) Decrtele Ibe avallabl. lifetime cx)v.,.. or any odIer inIured -fit; (2)

Rcault In III)' COlt 1O)'OW tamlly: (3)Increao praniuma or 1_ to ~ dllCOfttlnuatlon ofbeneflla or iDlwance: or (4)1U*.y 10Mof~ child', eli&lbillty for hom.1Dd coramlUlity-bIIed waivers, bued on ...,... bealthof'Olat.edoxpendJrur..

• You 11'0not requiNd 10 provide )'OW'COI'IIeIIt,and your refbaI1 to do 10 will not prevent your child from recefvlq lIpKia1 edlleltloGlorvlcel at the exptDlO olebe Dlltrlct You are entitled to notice of your riPlllMUllly. A copy oftbt lfUluaJNodce olRl_1taa.ch8d.

WltW,.•••I., Co •••• t:• The ,and", of content II voJuntIr)' and may be wldldrawn at any time. Howewr, If)'ou moke yo•• coftllnt, .udl reYDCIdoft It

not r'CCroICtive(I•••• It does DOlneaate 1ft acdoa that occumd after the COfIIItIt wu liven and befOre 1M corwent wu revobd.)

AtmlOlUZATlOH

I adcnowlcdp receipt of I NotIce of Ripa c:onctmm, Medicaid R.eUnbwttment, and r hive reed IDd t.IIICietUnd thole riaID priorto liplDa dlII Qln •• nt form. I bertby luthorize the DiI1rica to shiro '*'IIII'Y fnfonneclon ftom the ,bow-named chUd', tlb:1doarecords to IPPIy tor Moctieaid nlmbunemtnt for any healtlt-NlIted _JDOIDIlvl1uadona for wtdch I ba" stwn COGIInt. Iundmcand 1UICI."..lhtt the Diltrict may ••• the above-named child'. public b•• ftlt or il'llUnDCt to PlY fur any hllJch.relllecl..me •• provided purIUIftt to Put 300 of Title 34 oftbe Code olFoderai R.epIadon tDd IlarecIlII1ft)' IEP d\It I ••••• llpeeI. or torwhich I have othInvC. liven •••• writtIn pennjajon. I uncSenIInd dill thII COftHnt will retnain IIIt&ct pa1RlMlldy, l1li1••• 1revoke my COftIIIlt In wrlltna.Ya No I authorize the Dillbic:t to share necoaary Infonnldon to apply tor Medicaid "Jmbu.rMmeat.

Pllrui1l:uaMiIi. I•••••,.. Ii••mm/ddIyyyy

Plouo _d compIlICedform 10 School Medtc.!d Dept

Request for Confirmation of Enrollment and Attendance

Date of Request:

The student lilted below attended ---- , (orlglnatjng achool)

in (originating district) from untY

Student', Infot7Tl8tion

Lalt NameFirst Name

Middle NameDlte of Birth

Colorado 10 # (SASIO)

The laat correspondence with thl' ltudent', parent/guardian Indicated that helthe Intended toenroll In (lc:hocl) in (dlltrict).

Pleale provide rnponlea to the five Items below and retum thil form, by mill or fix. to:Bayfield High School800 C. R. 501Bayfield, CO 81122(970) 88••..9521(gl~)884~22~ EAX _

1 B The student Iisled abovi hli not .nrolled in our districtThe ltudent lilted abOve enrolled In our diltrict on .. (date).·

2. 0 The Itudent Iltled above h•• not attended cia •••• In our dlstrlclo The student lilted above began Ittendlng elUtes In our district on ~_ (date).·

3. • Conftnn name and mailing add,... of ltudlnfl new lCllool or .gency If applicable:Name of New School or Agency: _

Street Addrell:City: State: ZIP:

4. 0 W. do not require the stud.nfa eduCltional record, at thl. time.I 0 Pl•••• folWlrd the ,tudent'. educational record, It ttl!, time.

5. SIgnature of the SchooVDlslrlct Representative provIdIng this Information:

SIgn8luli Title Oat. PIIoIMt-' -

nt. FMfl/lrEtJucatIon.IRlghli Md PftoIeI;yAct (20 U.S. C. f 12~; 34 CFR Part U), I. ,.wWct, .,. ••• (~ An ~ tpIIIOy orIn.t/rut/on trMy dIIc/()H ~~ ~"lnfctm«lon II'om til ~'1011 rtCOIfJ of It sludetIt WfPhoIA ",. lrittll oon.nt 01theparttJt of Ihe ItUi»nt 01 the eMgIbIe Itudent II (1) The dI«JoaurI " 10oIhw .:hooI oft:MI8. IItcItJtIIng 1NohetI, within ltNI .~ orl/JltIfution h., dfItoMm/Md10 haw ~I" 'OUO'lIonaIln"""... ('2) 17Ie dItrlIbttn II 10 aIWoIM 0I11tO~ IChooI or «JhooIIY'fIMIIn WII/ch tile Mua.nt ••• 1eI or IntMdllo .lII0I.

J/C'(fJlftllll'fI,it"J ('OJ/IIln/tlll_'" ')11.,,,.,,1/1.,,,,,, ttll'·'H/,J"I.("

I orlll "I,tI"/~'rl I {l11J1j

Request for Release of School RecordaSollcltud de Llbetacl6n de reglstros esco/ates

AI firmar esta forma autorlza la escuels anterior de su estudlante a liberar los reglstros del estudlante.

Nombre y dlrecci6n de la escuels de donde sollclta los datos:

Student Name Nombre de esfudlante Grade GrariO

Name of previous school Nombre de escue/a antertor

Address Dfreccl6n

City eluded _ _ _ State Estado Zip Codlgo Postsl

Fax Numero de faJ(PhOO8 Numero de fe/efono

SIgnature of ParentlGuardlan Firma de Padre/Guardian Date F9Cha

Psra uso ex/us/vo de /s Escue/s For School Use Only

Pleaae mall the following student record. to:Bayfield High School

24 Clover Drive (mailing) • 800 C.R. 501 (physical)Bayfield, CO 81122

Phone (970) 884-9521 • Fax (970) 884-04226

:j

:( Date student was Inactlvatedlwfthdrawn from your district:"qj:,f;;fi Is student receiving Special Education Services? Yes No _

!I (If on and IEP, pi•••• notify u••• loon a. possible so we can make the approprlat. pl.coment)

;1 Is student receiving any other speclel services? (504 plan, ILP, Title I, ESL) Yes No __I.Iti~fto:nII

:1'I

~it,

il!

ir

"_----_. - .--

Has student been expelled from school? Yes No _

follow;n", plq8fO fax as soon as possibfo:

Birth Certille." Immun/z.tlons

School Official.. __ .._ _._..._..._ Date .. . _

STATE 'OF COLORADOJohn W HlCilenlOOper. C'>overnorLarry Wolk. MO. MSPH

EK6culive Director and Chief Medical Oltlcer

Dodicaled 10protecting and Improving the health and enwor'tment ollha peO!)Ieof Colorado

~JOO Cherry Creek Dr S LabOralory ServiCes DiVISionDenver. Colorado 80246-1530 8100 Lowry Blvd.Phono (303) 692·2000 Derwer, CQlo'ado 80230-6928localOOln Glerrdole, COlorado (303) 69:!·3090

www,CO(orado.gov/cdphe

ColoraJo Dcp:annlCntof Pub Iii. IlultI,~ndEnyjronmcttl

December 2013

Dear Parents of Students in Colorado Schools, k through 12th Grades (School Year 2014-15),

Immunizations are an Important part of our children's health care, and Colorado law requires that children going toschool be vaccinated to prevent vaccine-preventable disease. The purpose of this letter Is to let you know which

vaccines are required for school attendance ilnd which vaccines are recommended for best protection againstvaccine'preventable disease (see chart on second page).

As a parent, it Is important to know that in addition to the vacctnes required by the state of Colorado Board of

Health for school entry, there are vaccines that are recommended by the Advisory Committee on ImmunizationPractices (ACIP). This is the Immunization schedule that will best protect your child from even more vaccine-preventable diseases.

Parents often have concerns or want more Information about children's Immunizations and vaccine safety. Aresource developed for parents with frequently asked questions about the safety and importance of vaccines canbe located ilt: www.lmmunlzeForGood.cQm. The Colorado Immunization Section's website Is located at:www.Coloradolmmunlzatlons.com ,

Schools work hard to ensure compliance with the immunization laws. Your help In providing updated

Immunization records at school registration and when your child receives additional vaccine(s) Is greatlyappreciated. Please discuss your child's vaccination needs with y~ur child's doctor or local public health agency.(To find your local public health department's contact Information call the Family Health line at 1-303-692-2229 or1-800-688-7777). Please bring your child's updated immunization records to the school each time your childreceives an immunization.

Sincerely.

Colorado Immunization Section

Colorado Department of Public Health and Environment303-692-2700

,..-j

s

..-~--

III

"z"tit:ur.t

N•...o

---.,----",_._----