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Healthy Warriors


Lafayette County Health Department

729 Clay Street - Darlington, Wisconsin 53530

                                  (608) 776-4895 --- Fax (608) 776-4885

     Public Health-Home Care-

Personal Care-Environmental Health


Dear Parents/Guardians of Current 5th, 7th and/or 12th Graders:


Wisconsin Student Immunization law requires Tdap vaccine for students entering 6th grade.  Parents are required to have their children vaccinated or claim a waiver.  


Tdap is the adolescent combination vaccine that protects against tetanus, diphtheria, and pertussis (whooping cough).  Only one dose is required.


Two doses of Meningococcal Vaccine are recommended for adolescents 11-18 years of age: the first dose at ages 11 or 12, with a booster at age 16.  If the first dose is given after the 16th birthday, a booster is not needed.


The Meningococcal Vaccine protects against a serious bacterial illness. Meningitis is an infection of the covering of the brain and the spinal cord.  Depending on age, 1-2 doses are recommended.


If you have any questions or concerns please feel free to contact me at

608-439-5400.


4K Forms and Requirements


REQUIRED:


  1. Birth Certificate

  2. COMPLETED Health Form  (GREEN)

  3. Immunization Record (YELLOW)  (see informational sheet for minimum requirements)

  4. Medication Form (BLUE)



OPTIONAL:


  1. FERPA/HIPPA Consent (in case I need to contact your doctor for information or updates)

  2. Flu Shot Consent (Dates to be determined next fall)*

  3. Dental Clinic Consent (Dates to be determined)*


*May be scheduled on a day your child is not at school, but you can bring the child in for services


5K Forms and Requirements


REQUIRED:


  1. Birth Certificate (If did not attend 4K at Black Hawk)

  2. COMPLETED Health Form  (GREEN)

  3. COMPLETED Doctor Physical (GOLD)

  4. Immunization Record (YELLOW)  (see informational sheet for minimum requirements)

  5. Medication Form (BLUE)

  6. FERPA/HIPPA Consent (PURPLE) In the event I need to contact your doctor for information or updates



OPTIONAL (but strongly encouraged):


  1. COMPLETED Eye Exam Form (WHITE)

  2. DENTAL FORM to be completed by Dentist (PINK)

  3. Flu Shot Consent (Dates to be determined next fall)*

  4. Dental Clinic Consent (Dates to be determined)*


*May be scheduled on a day your child is not at school, but you can bring the child in for services.