If your child does not attend pre-kindergarten or school away from the child care operation, one of the following must be presented when your child is admitted to the child care operation or within one week of admission.
Right Eye 20/blanks field. Left Eye 20/ blank
The following vaccines require multiple doses over time. Please provide the date your child received each dose.
Signature or stamp of a physician or public health personnel verifying immunization information above:
Varicella (chickenpox) vaccine is not required if your child has had chickenpox disease. If your child has had chickenpox, please complete this Statement. My child had varicella disease (chickenpox) on or about (date) blanks and does not need varicella vaccine.
For additional information regarding immunizations, visit the Texas Department of State Health Services website at www.dshs.state.tx.us/immunize/public.shtm.