CONDITIONAL ENROLLMENT FORM For children attending 2026

1. Click ‘Get Form’ to open it in the editor.
2. In Section 1, enter the name of the school and the child's name along with their date of birth. Ensure accuracy as this information is crucial for enrollment.
3. Check all applicable vaccines that are missing or invalid. This includes options like DTaP, Hib, HepB, MMR, and others. Make sure to indicate the specific doses required.
4. Move to Section 2, where a physician or their representative must fill in details regarding any scheduled vaccinations or serologic testing. Include the disease for which vaccination is due and appointment dates.
5. In Section 3, the parent or guardian must acknowledge understanding of conditional enrollment by signing and dating the form. It’s important to provide proof of immunization by specified dates.

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