California Pre-Kindergarten and School Immunization Record
The California Pre-Kindergarten and School Immunization Record is an essential form for recording required vaccinations for school-aged children. This document ensures compliance with vaccination requirements set by the California Department of Public Health. It is crucial for parents, guardians, and school officials to maintain accurate vaccination records for new admissions.
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How do I fill this out?
To fill out the California Pre-Kindergarten and School Immunization Record, gather the pupil's immunization information beforehand. Begin by completing the pupil's identification section as per the guidelines. Ensure to accurately fill out the vaccine and dose section using the immunization history provided by the parent or guardian.

How to fill out the California Pre-Kindergarten and School Immunization Record?
1
Complete the pupil's identification section.
2
Record the dates of vaccination doses.
3
Check for any exemptions and document accordingly.
4
Initial and date the review for admission requirements.
5
Submit completed immunization form.
Who needs the California Pre-Kindergarten and School Immunization Record?
1
Parents or guardians of school-aged children need this form to ensure their children meet immunization requirements.
2
School health officials require this form for maintaining compliance with state health regulations.
3
Child care providers use this document for tracking children's immunization status.
4
Healthcare providers may need this form to verify a child's vaccination history.
5
Foster care agencies utilize this form to ensure health safety for children in their care.
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What are the instructions for submitting this form?
Submit the completed California Pre-Kindergarten and School Immunization Record to your child’s school or childcare provider. You may submit the form via email to the designated health office, fax to the school's administrative office, or deliver it physically to the school. Ensure that all information is accurate to avoid delays in enrollment.
What are the important dates for this form in 2024 and 2025?
Important deadlines include submission of immunization records prior to school admission, typically required before the start of each academic year. It is essential to keep vaccination schedules up to date to avoid any delays in enrollment. Be aware of specific cut-off dates for vaccinations as dictated by school policies.

What is the purpose of this form?
The purpose of the California Pre-Kindergarten and School Immunization Record is to ensure that children attending school or childcare facilities are up-to-date on their vaccinations. This form assists in tracking the immunization history and compliance with state health regulations. By maintaining accurate records, guardians and educational institutions contribute to the overall health and safety of the community.

Tell me about this form and its components and fields line-by-line.

- 1. Pupil Name: Records the full name of the pupil.
- 2. Statewide Student Identifier: A unique 10-digit identifier for tracking students.
- 3. Ethnicity: Specifies the pupil’s ethnic background.
- 4. Vaccine Doses: Records details of each required vaccine dose.
- 5. Status of Requirements: Indicates whether vaccination requirements have been met.
What happens if I fail to submit this form?
Failing to submit this form can hinder a child's admission to school or childcare facilities. Without proper documentation, children may be at risk of exclusion from class. It is critical to ensure timely submission to maintain compliance with public health mandates.
- Delayed Admissions: Without the form, children may not be allowed to attend school.
- Health Risks: Non-compliance can lead to increased health risks in the community.
- Legal Consequences: Schools may face penalties for not maintaining proper records.
How do I know when to use this form?

- 1. Enrollment in Pre-Kindergarten: Needed when a child enters early education programs.
- 2. School Transfers: Essential for transferring students to verify immunization status.
- 3. Advancement to 7th Grade: Required for advancing students who must meet specific vaccine criteria.
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Is there a limit to the number of edits I can make?
No, you can edit the document as many times as necessary before downloading it.
What does the review process entail?
The review process involves checking the completed immunization record against the requirements before submission.
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What if I need to collaborate with others on this document?
You can share the document via link for collaboration or use email to send it directly to others.
How do I know if the immunization record is filled out correctly?
Refer to the guidance provided on the document to ensure all necessary fields are completed properly.
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