1. Instructor Guide Version 2.0 Instructor Notes:
Consider distributing these forms for ease of review:
Guide to Immunizations Required for School Entry
Table 2 Conditional Admission Immunization Schedule
Blank Blue Card
Blank Notice of Immunizations Needed letter
Windows for Immunizations for Schools and California Immunization Handbook (recommended)
As participants introduce themselves, ask them to describe roles or duties they currently perform around immunization requirements. Tie their experiences to the next slide.
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California Department of Public Health, Immunization Branch

2. Under California law, children are required to receive certain immunizations in order to attend public and private elementary and secondary schools, child-care centers, family day care, nursery schools, nurseries, and developmental centers.
The California School Immunization Record is the key instrument for documenting childhood immunizations at the school.
You play an important role by:
Minimizing exclusions from school;
Protecting your facility from preventable disease outbreaks;
Helping busy parents keep their kids on track with shots;
Ensuring your school complies with state law.
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3. Tools & Resources
Available at Local Health Departments
CAIR
There are many resources available to help you understand the state requirements and help protect your school from vaccine-preventable diseases.
ShotsforSchool.org
This online portal is a great resource for brochures, flyers, posters, frequently asked questions, forms, letters, and more targeting child care, schools, and parents.
California Immunization Handbook (Blue Book)
This electronic resource provides links to many of the resources posted on ShotsforSchool.org, and it will be updated as laws change. Download and print your free copy at ShotsforSchool.org – Laws – Handbook, Records, & Materials.
California School Immunization Record (Blue Card)
This official state document records immunization history for every child admitted into child care or schools. You may obtain copies from your local health department.
Window for Immunizations
This tool helps you determine whether school immunization requirements have been met. You may obtain copies from your local health department.
California Immunization Registry (CAIR)
CAIR is a secure, online, statewide network of computerized immunization information systems that provides rapid access to available immunization records. CAIR can also print a copy of the California School Immunization record.
Blue Card Online and at
Local Health Departments
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4. Up-to-Date Online Resource
We’ll focus on the tabs across the top as well as the “Immunization Reporting” and “New Laws” sections that are accessible from the ShotsforSchool.org Home page.
These resources will help your school comply with state law and prepare you to help parents make informed decisions regarding immunization.
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5. What Will I Learn? By the end of this lesson, you’ll be able to:
Locate immunization requirements by age and grade
Describe the ways children may be admitted
Implement immunization requirements
Create a year-round immunization plan
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6. Locate Immunization Requirements
Details on the specific number of vaccine doses required by age and grade for child care and schools are defined by the California Code of Regulations. Download the Guide to Immunizations Required for School Entry from the Home page to print immunization requirements by age and grade.
You may also use Immunizations Requirements for K-12 (California Code of Regulations, Title 17, Section 6020, Table 1) as an alternative to the guide. This document can be found on “Shots Required for K-12” menu on ShotsforSchool.org.
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7. Locate Immunization Requirements Entry for TK/K-12
Ages 4-17 years:
Entering elementary school (4-6 years)*
Transferring into a CA school
Entering 7th grade
Instructor Notes:
Help them understand the guide:
Column (1): List of required vaccines;
Column (2): Entry requirements for TK/K and 1st grade if 4-6 years;
Column (3): Entry requirements for any child considered a new admission for children age 7-17 years, including those transferring from another state or country;
Column (4): Entry (advancement or admission) requirements for 7th grade. They may also use Table 1 from California Code of Regulations Section 6020.
The bottom portion of the guide focuses on how to determine if requirements have been met. Consider deferring those questions until the next section.
TK/K-12:
Staff in schools are required to check immunization requirements for children entering TK/K (4-6 years of age), again at 7th grade, and for any child newly admitted to a CA school including transferring from out of state. Students in transitional kindergarten (TK) are subject to the kindergarten immunization requirements before admission into the first year of the program.
You will commonly see MMR (combination of Measles, Mumps, and Rubella antigens) on immunization records, but single-antigen vaccines not currently available in the US meet the requirement for measles immunization: one dose of each, separately or combined, on or after the first birthday. Children entering kindergarten (or first grade if kindergarten is skipped) and also 7th grade are required to have two doses of measles-containing vaccine, both given on or after the first birthday. Refer to California Code of Regulations, Title 17, Section 6020, Table 1 or the guide as needed.
* Includes transitional kindergarten (TK).
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8. Locate Immunization Requirements Entry for TK/K-12
Self Check
Jeff is 4 years old and about to enter transitional kindergarten.
Which immunizations are required for entry based on his age and grade?
Instructor Notes:
The goal of this self-check is to help them get familiar with the guide and understand how it can be used to identify requirements for entry by grade. Later we will discuss how to determine if immunization requirements have been met using the child’s immunization record and follow-up systems.
Refer participants to a printed version of the guide to make it easier for them to read.
Direct the self-check question to those working in TK/K-12.
Advance the slide to reveal the answer and point to the highlighted column that lists all immunization requirements for entry.
Your answer and notes:
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9. What Will I Learn? By the end of this lesson, you’ll be able to:
Locate immunization requirements by age and grade
Describe the ways children may be admitted
Implement immunization requirements
Create a year-round immunization plan
Now that you know where to locate the immunization requirements for age and grade, let’s review the ways children may be admitted including medical exemptions, conditional entry, and transfers.
This section reviews entry requirements according to California regulations. Later we’ll address the actual steps that you’ll go through to determine whether or not these requirements have been met.
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10. Describe How Children May Be Admitted Immunizations Are Current
Children may be admitted if they:
Are 4 years or older and have received all required immunizations for age and grade.
What does this mean?
Children who are current on all required immunizations and have no remaining doses for their age or grade may be unconditionally admitted. They do not require follow-up for subsequent immunizations until the next check point.
Children 4 years or older may be unconditionally admitted to elementary or secondary school if they have received all required immunizations for age and grade. They do not require follow-up for subsequent immunizations until the next checkpoint (that is, 7th grade). We will talk later about how to follow up at future check points.
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11. Describe How Children May Be Admitted Permanent Medical Exemption
Children may be admitted if they:
Have filed a valid statement of Permanent Medical Exemption and immunization records for all other required doses.
What does this mean?
A licensed physician determines that one or more vaccine(s) is not indicated due to a permanent physical condition or medical circumstance. A valid Permanent Medical Exemption requires submission of a licensed physician’s written statement which states:
the physical condition or medical circumstance of the child is such that the required immunization(s) is not indicated,
the vaccine(s) to be exempted, and
the medical exemption is permanent.
Children may be unconditionally admitted if they have submitted a valid, written statement of Permanent Medical Exemption from a licensed physician and immunization records for required shots not exempted. For example, if a child has a suppressed immune system, live viruses may not be indicated.
A valid statement of Permanent Medical Exemption requires submission of a licensed physician’s written statement which states the:
Physical condition or medical circumstance of the child is such that the required immunization(s) is not indicated,
Vaccine(s) to be exempted, and
Medical exemption is permanent.
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12. Describe How Children May Be Admitted No Classroom-Based Instruction (per SB 277)
Children may be admitted if they:
Attend a home-based private school, or an independent study program and do not receive classroom-based instruction—even if they have not received all required immunizations for age and grade.
What does this mean?
Starting January 1, 2016, SB 277 states that these children do not need to receive the required immunizations in order to be admitted, but parents or guardians must continue to provide immunization records to their schools, and schools must continue to maintain and report records of immunizations that have been received.
Students who have an individualized education program (IEP) should continue to receive all necessary services identified in their IEP regardless of their vaccination status.
Instructor Note:
The last slide in the deck summarizes SB 277.
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13. California Code of Regulations
Describe How Children May Be Admitted Conditional Admission for TK/K-12
Children may be admitted if they:
Meet one of these conditions for conditional admission:
California Code of Regulations
A valid Temporary Medical Exemption requires submission of a licensed physician’s written statement which states:
the temporary physical condition or medical circumstance of the child is such that the required immunization(s) is not indicated;
the date when the temporary medical exemption will end, and
the vaccine(s) to be exempted.
Instructor Notes:
Help them understand the interval windows. Make sure they understand the last day of the interval is the deadline. See California Code of Regulations, Title 17, Section 6035, Table 2.
Children are admitted conditionally and considered conditional entrants until they meet all the requirements for TK/kindergarten.
If children have received at least 1 dose in a series, they will have an interval of time to receive the next dose. See California Code of Regulations, Title 17, Section 6035, Table 2. For example, the child may receive the next dose as early as 4 weeks after the previous dose, but the child has up to 8 weeks to get vaccinated. The last day of the interval is the deadline. The child may be admitted conditionally if the deadline for the next dose (8 weeks in this example) has not passed.
A valid statement of Temporary Medical Exemption requires:
A licensed physician’s written statement,
Statement that there is a temporary physical condition or medical circumstance that rules out one or more vaccines (the specific medical condition does not need to be identified),
The date when the temporary medical exemption will end, and
The specific vaccine(s) the child cannot receive.
Refer to California Code of Regulations, Title 17, Sections 6035 & for more details.
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14. Refer to “Laws” Tab for Details
For more information on conditional admission, refer to the FAQs and the text of the law, all posted online under the “Laws” tab.
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15. Describe How Children May Be Admitted Transfers
Children may be admitted if they:
Are transferring from another school—within California or from another state—and all immunization requirements are met.*
What does this mean?
The new school must review the student’s immunization records to make sure all immunization requirements have been met.
If a student’s immunization record has not been received by the time of transfer, schools may admit the child for a period of up to (30) school days while waiting for the record to arrive or be submitted to the school.
For children transferring from another school or from another state, the new school must review the student’s immunization records to make sure all immunization requirements have been met. A valid record includes the Blue Card from the prior school, another state’s school record (provided it includes dates for all immunizations), or the child’s personal immunization record.
If parents cannot provide immunization documentation or the cumulative folder has not arrived from the previous school at the time of admission, the new school may admit the child for up to 30 school days while waiting for records. Schools are not required to allow this time period (California Code of Regulations, Title 17, Section 6070 (e)).
Children transferring in may be admitted unconditionally or conditionally as covered in items #1-4.
* Exemption for transfer students with PBEs filed prior to 2016 is covered on slide 17.
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16. FAQs are available to assist
Personal Beliefs Exemptions No Longer an Option for New Admissions (Effective 1/1/2016)
FAQs are available to assist
For more information, refer to SB 277 FAQs (in English, Spanish, and Russian) on the ShotsforSchool.org website.
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17. Describe How Children May Be Admitted Transfers with PBEs Filed before 2016 (per SB 277)
Senate Bill 277 (Pan, 2015)
Parents of students in any school or child-care facility are no longer allowed to submit a new personal beliefs exemption (PBE) to a currently required vaccine.
For transfer students, a PBE filed before 2016 at:
Entry to any grade from TK/K through 6th grade will remain valid until the child completes 6th grade.
Entry to any grade from 7th through 12th will remain valid through 12th grade.
Instructor Note:
The last slide in the deck summarizes SB 277.
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18. Describe How Children May Be Admitted
In summary, children may be admitted if they:
Are 4 years or older and have received all required immunizations for age and grade.
Have filed a valid statement of Permanent Medical Exemption and immunization records for all other required doses.
Attend a home-based private school, or an independent study program and do not receive classroom-based instruction—even if they have not received all required immunizations.
Qualify to be admitted as conditional entrants.
Are transferring from another school—within California or from another state—and meet immunization requirements.
One and two are considered unconditional admission and do not require follow-up for subsequent immunizations until the next check point (that is, 7th grade).
The children in three do not need to receive the required immunizations in order to be admitted, but parents or guardians must continue to provide immunization records to their schools, and schools must continue to maintain and report records of immunizations that have been received.
No shots? No records? No school.
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19. Conditional Entrants For TK/K-12
Self Check Under which two conditions may children be admitted in TK/K-12 as conditional entrants?
Instructor Notes:
Participants may have to explain to parents why their children may not be admitted. The goal of this activity is to see if participants can describe in their own words the conditions that satisfy the law for entry as a conditional entrant. Refer them to California Code of Regulations, Title 17, Section 6035, Table 2.
Read the question and direct it to the TK/K-12 participants. Click to reveal the table and review the expected responses.
Your answer and notes:
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20. What Will I Learn? By the end of this lesson, you’ll be able to:
Locate immunization requirements by age and grade
Describe the ways children may be admitted
Implement immunization requirements
Create a year-round immunization plan
Now that you understand the ways children may be admitted according to California regulations, let’s discuss the actual steps that you’ll go through to determine whether or not these requirements have been met.
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21. Implement Immunization Requirements Step by Step: Preparing for 1st Day
Before starting, you’ll need these items:
Student’s personal immunization record (yellow card, CAIR, or other record);
California School Immunization Record (Blue Card); (Obtain original from their cumulative folder or a blank one to fill out, or print from CAIR.)
Guide to Immunizations Required for School Entry;
Your school’s follow-up system (to add entries as needed).
Tip: The Window for Immunizations is a free resource that helps you identify missing immunizations required for schools.
Instructor Notes: Preparing for 1st Day
Point out that as parents or guardians begin turning in their child’s immunization records, staff or nurses may need these resources to begin processing each child for entry.
Consider distributing these forms for ease of review:
Yellow cards
Blank Blue Cards
Guide to Immunizations Required for School Entry
Table 2 Conditional Admission Immunization Schedule
Blank Notice of Immunizations Needed letter
Window for Immunizations
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22. Implement Immunization Requirements Step by Step: Preparing for 1st Day
In preparing for 1st day, school staff needs to:
Obtain the child’s personal immunization record—even if the child has an exemption.  
Complete the top portion of the Blue Card and transfer vaccine dates from child’s personal immunization record. (Or printout from CAIR.) (Follow instructions on the back of the Blue Card.)
Determine if requirements are met by comparing number of doses on the Blue Card to the Guide to Immunizations Required for School Entry.
If child has a Permanent/ Temporary Medical Exemption, make sure that immunization records are submitted for any vaccines not exempted.
Complete the Documentation and Status of Requirements box. (Follow instructions on the back of the Blue Card.)
File the completed Blue Card in the child’s cumulative folder.  (Schools must keep this record on file for every child enrolled.)
Instructor Notes: Preparing for 1st Day (spring-summer)
Refer participants to sample CA Immunization Record and Blue Card as you review the steps. Point out that instructions for completing the Blue Card are on the back of the card. This slide assumes records have been provided for all required shots or valid exemptions have been submitted. The process for admitting conditional entrants is covered shortly.
Notes:
1. CA immunization record (or equivalent) could be any immunization record, a Blue Card transferred from prior school, computer printout, CAIR record, immigration record, out-of-state school records, etc. that includes: child’s name, date of birth, vaccine name or abbreviation, date vaccine administered, clinic name (written or stamp), office, or health-care provider administering the vaccine.
2. Complete the child’s identifying information on the top of the Blue Card or ask the parents to fill out this section only. Transfer dates (month/day/year) for each vaccine the child has received onto the Blue Card. Staff fill in the vaccine date (month/day/year) of each vaccine documented on the immunization record.
3. Determine if requirements have been met. Check the timing of doses only for the immunization doses specified for the 1st, 2nd, or 4th birthday. For these doses, a dose given up to (and including) four days before the birthday meets the requirements. Certain immunizations require the full date (e.g., MMR given during month of 1st birthday and Tdap given during month of 7th birthday).
4. If a medical exemption is requested for a vaccine(s), ensure that the Permanent/ Temporary Medical Exemption statement is complete.  Make sure that immunization records are submitted for any vaccines not exempted.
5. We’ll review how to fill out the Documentation and Status of Requirements box in the next slides.
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23. Here is a sample completed Blue Card with sections for the child’s identifying information at the top, the vaccines dates transferred from the child’s immunization record, and the Documentation, Status of Requirements, and 7th Grade Entry box. Detailed instructions are on the back of the Blue Card.
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24. Implement Immunization Requirements Step by Step: Preparing for 1st Day
For 2016 only - Special note for kindergarten students previously in TK at an elementary school in :
If a student entered an elementary school TK with a valid PBE (signed within 6 months prior to TK entry and filed before January 1, 2016), the PBE remains valid from TK through 6th grade.
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25. Implement Immunization Requirements Step by Step: Preparing for 1st Day
Special note for 7th graders: Students entering 7th grade who had a PBE filed for the TK-6th grade span will need to meet all requirements for both 7-17 Years Old and 7th Grade.
PBEs filed in the TK-6th grade span will no longer be valid once the child completes 6th grade. Students entering 7th grade who had a PBE filed for the TK-6th grade span will need to meet all requirements for both 7-17 Years Old and 7th Grade. Refer to the “Guide to Immunizations Required K-12” or California Code of Regulations, Title 17, Section 6020, Table 1.
Students entering 7th grade who had a PBE filed for the TK-6th grade span will need to meet all requirements for children 7-17 years old (e.g., polio, MMR, chickenpox, and primary series for diphtheria, tetanus, and pertussis) in addition to shots required for 7th grade (Tdap and two doses of MMR). 1 Tdap dose on or after 7th birthday may count toward the 3 doses of diphtheria toxoid, tetanus toxoid, and pertussis vaccine requirement.
Two doses of any measles-containing vaccine meets the measles requirement for 7th grade advancement or admission. Currently, MMR is the only measles-containing vaccine available in the United States.
A child may be admitted conditionally if the child is not due for any doses at the time of admission.
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26. California Code of Regulations
Implement Immunization Requirements Step by Step: Preparing for 1st Day
Special note for 7th graders:
Document the date of Tdap immunization.
Affix and complete Tdap sticker. 02 15 01
2004
California law requires that all students entering 7th grade have received a Tdap booster shot.
Tdap stickers are to be completed by school nurses or staff--not by children or their parents or guardians. Children either meet the Tdap requirement or they don’t and should not enter 7th grade without documentation of Tdap or a valid exemption.
Affix the Tdap sticker to the child’s Blue Card in the upper corner to document Tdap vaccine. Instructions for Tdap stickers may be accessed under the “7th Grade” menu option “Tools for Schools”.  
Refer to California Code of Regulations, Title 17, Division 1, Chapter 4, Subchapter 8 for more details.
California Code of Regulations
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27. Implement Immunization Requirements Preparing for 1st Day: Permanent Medical Exemption
California School Immunization Record
Instructor Notes: Permanent Medical Exemption
Refer participants to their Blue Cards to make it easier to read.
Remind participants of highlighted elements required for a valid statement of PME.
Point out that vaccine dates must be filled out for required immunizations not exempted.
Status of Requirements section must be filled out by checking boxes A (and dating) and C.
This is a sample of a completed Blue Card with immunization dates filled in for all vaccines not specifically exempted by the permanent medical exemption.
If immunization requirements are met, update the Status of Requirements section by checking boxes A (and dating) and C.
Remember: A valid statement of Permanent Medical Exemption requires:
A licensed physician’s written statement,
Statement that there is a permanent physical condition or medical circumstance that rules out one or more vaccines (the specific medical condition does not need to be identified), and
The specific vaccine(s) the child cannot receive.
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28. Implement Immunization Requirements Preparing for 1st Day: Temporary Medical Exemption
California School Immunization Record
Instructor Notes: Temporary Medical Exemption
Refer participants to their Blue Cards to make it easier to read.
Remind participants of the highlighted elements required for a valid TME.
Point out vaccine dates must be filled out for all required shots not exempted.
Status of Requirements must be filled out by checking boxes B and D.
This is a sample of a completed Blue Card with immunization dates filled in for all vaccines not specifically exempted by the temporary medical exemption. In this example, the child would meet the requirements for conditional entry if he or she presented a valid statement of Temporary Medical Exemption and immunization records for required shots not exempted. If the child meets the requirements for conditional admission, update the Status of Requirements by checking boxes B and D.
Important: You will need to follow up to remind parents before shots are due.
Remember: A valid statement of Temporary Medical Exemption requires:
A licensed physician’s written statement,
Statement that there is a temporary physical condition or medical circumstance that rules out one or more vaccines (the specific medical condition does not need to be identified),
The date when the temporary medical exemption will end, and
The specific vaccine(s) the child cannot receive.
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29. Implement Immunization Requirements Preparing for 1st Day: Conditional Admission
Missing doses? Look to Table 2 to determine if child may be admitted.
As you determine whether entry requirements are met, if the child is missing doses, use California Code of Regulations, Title 17, Section 6035,Table 2 to determine whether the child may be admitted conditionally. They will need at least the first dose in each series before admission and have an interval of time to receive the next dose in a series. The last day of the interval is the deadline. The child may be admitted conditionally if the deadline for the next dose has not passed.
NOTE: Table 2 includes the conditional admission requirements for TK/K-12. You may alternatively use the separate Guide for Immunizations Required for School Entry to determine conditional admission.
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30. Implement Immunization Requirements Preparing for 1st Day: Conditional Admission
Use Notice of Immunizations Needed letter to notify parents of vaccines due before admission.
TIP: We encourage you to use this template letter to notify families of vaccinations that are due before admission. The letter may be downloaded from ShotsforSchool.org by accessing the “Laws” tab and clicking on “Handbook, Records, & Materials.”
If requirements are not met by the first day or the child doesn’t meet conditional admission requirements, state law requires that schools do not admit the child:
“According to state law, we cannot allow your child to attend school unless we receive evidence that the above requirements are met by this date: [specify deadline].”
You may use multiple letters depending on the due date(s) for different doses and/or send new letters as parents submit updated records and new deadline dates are established for the next dose in a series.
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31. Implement Immunization Requirements 1st Day: Requirements Are Not Met
If children are either due for doses or missing documentation on the 1st day:
Do NOT admit or allow entry.
Refer parents or guardians to primary care provider to receive immunizations (or their local health department for additional resources).
You may use the Notice of Immunizations Needed letter and Parents’ Guide to Immunizations Required for School Entry to inform parents of the next doses needed.
Instructor Notes: Requirements not met the 1st day
Up to now we’ve been discussing preparation over spring and fall for the 1st day. Now discuss what schools should do if requirements are not met on the first day.
The California Health and Safety Code requires parents or guardians to provide proof of immunization for school entry. If children are missing either doses or exemption documentation or do not meet requirements for conditional admission, do not admit or allow entry.
The “No shots? No records? No school” posters (in English and Spanish) are available for download on ShotsforSchool.org under K-12/Tools for Schools menu with firm language to support you.
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32. Conditional Entrants Throughout the Year
Determine timing for the next dose in a series:
Instructor Notes: Follow-up for Conditional Entrants Throughout the Year
Transition from processing children for entry to following up throughout the year. Refer to their printed copy of Table 2 to make it easier to read.
Now that you’ve processed all children for school entry, you must follow up throughout the year to ensure those conditional entrants with doses due later provide required immunization documentation. California Code of Regulations, Title 17, Section 6035, Table 2: Conditional Admission Immunization Schedule shows when next doses are due.
The child may receive the next dose as early as the beginning of the time interval. The last day of the interval is the deadline. Up until that deadline, the child may be admitted “on condition” that the next and remaining doses are received by their deadlines. If documentation of the next and remaining doses is not received by their deadlines, the child should be excluded.
TIP: Recommend that children receive the next dose toward the beginning of the vaccine’s time interval from Table 2. 
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33. Conditional Entrants Throughout the Year
Step by Step:
Create a reminder entry in your follow-up system to notify parents or guardians when next shots are due.
You may use the Notice of Immunizations Needed letter and Parents’ Guide to Immunizations Required for School Entry to inform parents of the next doses needed. Please make sure you include the deadline.
Recommend that the child receive the next dose at the beginning of the vaccine’s time interval from Table 2. 
Review records every (30) days.
If you discover a child has missed the next dose and was not excluded, schools must notice parents or guardians and may give them up to (10) school days to comply before the child is excluded.
Instructor Notes:
This is the first time we are discussing the process of following up with conditional entrants to ensure continued attendance.
For conditional entrants, please make sure you include a deadline so parents are aware of the exclusion date. If a child has not received all immunization doses by this due date, state law requires that he/she be excluded:
“According to state law, we cannot allow your child to attend school unless we receive evidence that the above requirements are met by this date: [specify deadline].”
California Code of Regulations, Title 17, Section 6070 (f) requires that records for conditional entrants be reviewed every (30) days until all required immunizations are received and their records updated.
If you discover a child has missed the next dose and was not excluded, schools must notice parents or guardians and may give them anywhere from 0 to 10 school days to comply before the child is excluded. Refer to California Code of Regulations, Title 17, Sections 6040 and 6055.
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34. Conditional Entrants For TK/K-12
Self Check
Today is July 25, Anna is five years old and is starting kindergarten in 1 month.  Her last (2nd) dose of DTaP was 5 months ago.  Can she start classes in a month?
Steps
No.  You will count doses on the Blue Card and compare to the Guide to Immunizations Required for School Entry. She is behind on DTaP.
Compare the immunization dates on the Blue Card to Table 2 for interval timing to determine if the next dose must be administered before starting school. The third dose is due “before admission if 8 or more weeks have elapsed since the 2nd dose at the time of admission.”
What are your next steps?
Instructor Notes:
Scenario: Anna is five years old and is entering kindergarten in 1 month. She will need another DTaP shot before she can be admitted to kindergarten.
Read the self check. Remind participants that they will use the Guide to Immunizations Required for School Entry to determine immunization requirements for entry and use Table 2 to determine dosing intervals for any missing doses. Then click to reveal the answer.
Then ask: What are your next steps?
Refer parents or guardians to primary care provider to receive immunizations (or alternatively their local health department for additional resources).
Provide parents or guardians with the Notice of Immunizations Needed letter.
NOTE: Although two doses of varicella vaccine are recommended by ages 4-6 years, only one dose is currently required for kindergarten entry. A second dose of varicella vaccine may be recommended at this time, but NOT required for admission.
Your answer and notes:
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35. Transfers Throughout the Year
Step by Step for transfers (including homeless and foster children):
Review Blue Card from previous school, or
May ask parents or guardians to provide immunization records as soon as possible (or check CAIR).
If no records, can admit child for up to (30) school days while waiting for records.*
Follow up as necessary.
Complete Blue Card when records are received.
Instructor Notes: Processing Transfers Throughout the Year
See participant notes addressing in-state and transfers from a school in another state.
For children transferring from another California school or from a school in another state, review the student’s immunization records to make sure all immunization requirements have been met. For transfers from another state, you may use the immunization records from their previous school to fill out a new Blue Card.
If parents cannot provide immunization documentation or the cumulative folder has not arrived from the previous school at the time of admission, the new school may admit the child for up to 30 school days while waiting for records. Schools are not required to allow this time period (California Code of Regulations, Title 17, Section 6070 (e)).
If a child has a PBE on file before January 1, 2016, at a previous California school, the PBE is valid until entry into the next grade span and may transfer between schools in California during the same grade span.
Transfers of Homeless or Foster Children: If immunization records are missing or unavailable at the time of transfer to a new school, the federal McKinney-Vento Homeless Assistance Act requires schools to enroll homeless children immediately. California law requires schools to immediately enroll foster children when transferring to a new school if they are missing immunization records required for entry. Attempt to obtain immunization records quickly and work with local health departments (LHDs) to ensure these children receive required vaccinations.
Follow up on any children who met entry requirements but still need shots later.
Record Transfer Requirements: Education law provides that if a pupil transfers from one school to another within California, the pupil’s record shall be transferred by the former school no later than 10 school days following the date of request from the school where the pupil intends to enroll (California Education Code Section 49068).
For foster children, within two business days of the foster child's request for enrollment, the educational liaison for the new school shall contact the school last attended by the foster child to obtain all academic and other records. The educational liaison for the school last attended shall provide all records to the new school within two business days of receiving the request (California Education Code Section (e)(8)(C)).
* For children entering any grade from out of the country, do not allow additional days to await records. Review immunization records before admission and refer family to their physician or public health department as needed.
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36. Transfers Personal Beliefs Exemption – Filed Prior to 2016 (per SB 277)
II. Affidavit
California School Immunization Record
Instructor Notes: Example of Personal Beliefs Exemptions filed in 2014 and 2015
Refer participants to a Blue Card to make it easier to read. Point out that vaccine dates must be filled in for all required shots not exempted. Status of Requirements must be properly filled out by checking boxes A (and dating) and E.
PBEs filed prior to 2016 remain valid until the student enrolls in the next grade span (typically kindergarten or 7th grade).
This is a sample of a completed Blue Card with immunization dates filled in for vaccines not specifically exempted by the PBE form. Students with a PBE filed before 2016 will be transfers and will likely already have a completed Blue Card from the prior school. You may ask parents to bring their child’s immunization record rather than waiting for the prior school to send the child’s records (including the Blue Card).
A PBE form filed before January 1, 2016 at:
Entry to any grade from TK/kindergarten through 6th grade will remain valid until the child completes 6th grade.
Entry to any grade from 7th through 12th will remain valid through 12th grade.
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37. Transfers Personal Beliefs Exemption – Filed Prior to 2016 (per SB 277)
PBE forms filed in 2014 and 2015 are only valid when:
signed by both an authorized health-care practitioner and a parent/guardian, and
no more than 6 months prior to first entry into school or a new grade span (if the "religious beliefs" box was checked, then a practitioner signature was not required).
For PBEs filed prior to 2014: The personal beliefs affidavit on the back of the Blue Card, or similar PBE affidavit (including Tdap PBE form CDPH 8261), must be signed and dated by the parent/guardian.
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38. What Will I Learn? By the end of this lesson, you’ll be able to:
Locate immunization requirements by age and grade
Describe the ways children may be admitted
Implement immunization requirements
Create a year-round immunization plan
Let’s review a sample immunization plan that schedules the tasks we just covered throughout the year to minimize stresses on the first day.
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39. Create an Immunization Plan Best Practices
Instructor Notes:
Share with schools a list of clinics in your jurisdiction that can assist children without regular providers who need immunizations for school. Share your schedule for regular immunization clinics and any special back-to-school immunization clinics.
This sample immunization plan includes best practices you may find useful as you help your school implement immunization requirements. Adjust as needed for your school.
Planning ahead and communicating with parents early will make the first day of school run much, much smoother. Begin planning in winter-spring and adjust the plan according to your staffing levels over the summer. Remind parents that during July and August, it may be difficult to get a timely appointment with their child’s health-care provider due to the “back-to-school rush.”
Identify clinics to assist children without regular providers in need of immunizations to start school. Contact your local health department if you need assistance identifying clinics.
Remind students in 5th and 6th grade that PBEs will expire at advancement/admission to 7th grade so that they can start getting up to date on missing immunizations.
Tip: Inform parents of immunization requirements during school tours and 5th and 6th grade parent-teacher nights. Registration packet might include the Parents’ Guide to Required Immunizations for School Entry.
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40. Create an Immunization Plan Follow-up for Conditional Entrants
Set a schedule and check your follow-up system every 30 days for children with pending vaccinations.
Jane Doe 3rd DTP
James Doe 2nd MMR
TIP: Student information systems (for example, AERIES) may help automate follow-up on pending immunizations. Check the California Immunization Handbook for other ideas for follow-up systems.
CAIR provides a “Missing Immunization” report that you may run weekly to manage follow-ups with parents for immunizations due. Go to and click “Schools and Child Care” to find out how CAIR can help track immunizations.
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41. Create an Immunization Plan Complete Annual Immunization Reporting
Complete and submit the annual immunization reporting for Kindergarten and 7th Grade each fall.
Annual reporting of child immunization status is important for identifying pockets of vulnerability to vaccine-preventable disease spread. Records of immunizations and exemptions for each child allow schools to identify children who may be susceptible and remove them quickly to protect them in the event of disease outbreak or suspected disease exposure. Please consult your local health department in the event of incidents of disease or suspected disease exposure.
Child care (2 years through 4 years 11 months), kindergarten, and 7th grades are required to assess and report each fall the immunization status of their enrollees. Access immunization reporting from the Home page of ShotsforSchool.org. “Instructions” and “Frequently Asked Questions” are available online to help you complete the online immunization assessment.
Refer to California Health and Safety Code Section and California Code of Regulation Section 6075 for more details.
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42. How is Your Facility Doing? Based on Fall Immunization Reporting
Conditional and exempted children are at greatest risk for disease if there is disease exposure or outbreak. Facilities usually keep a list of these children to reference in the event of disease outbreak or suspected disease exposure.
ShotsforSchool.org offers an online resource to help you better understand how protected your school is based on annual immunization reporting data for kindergarten and 7th grade.  
This map displays your school’s up-to-date (UTD) rate calculated from your fall immunization reporting data. The UTD rate is the percentage of children in a school who received all required vaccines (that is, who are fully vaccinated). Additional information at
Your facility’s UTD rate may be lower than expected with larger numbers of children who are not fully vaccinated.
These rates are updated once a year based on fall immunization reporting data.
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43. Create an Immunization Plan Reportable Diseases
Schools must report incidents of certain infectious diseases to the local health department as soon as identified.
If the school has good cause to believe that a pupil has become ill or has been exposed to particular communicable diseases, that information shall be reported to the local health department immediately. The local health department can work with the school to determine if children need to be excluded and for what time period.  See California Code of Regulations, Title 17, Section 6060. 
The section of the law that lists reportable communicable diseases can be found in California Code of Regulations, Title 17, Sections 2500, 2593, , and Sections Reportable Diseases and Conditions.
California Code of Regulations
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44. Questions? No shots? No records? No school. You should now be able to:
Locate immunization requirements by age and grade
Describe the ways children may be admitted
Implement immunization requirements
Create a year-round immunization plan
No shots? No records? No school.
Questions on immunization requirements?
Call your local health department or
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45. Personal Beliefs Exemptions No Longer an Option for New Admissions (Effective 1/1/2016)
Summary of Senate Bill 277 (Pan, 2015)
Effective January 1, 2016, parents of students in any school or child-care facility are no longer allowed to submit a new personal beliefs exemption (PBE) to a currently required vaccine.
A PBE filed before 2016 at:
A child-care facility will remain valid until the child first enters the span between TK/K through 6th grade.
Entry to any grade from TK/K through 6th grade will remain valid until the child completes 6th grade.
Entry to any grade from 7th through 12th will remain valid through 12th grade.
Students are no longer required to have immunizations for entry if they attend a home-based private school or an independent study program and do not receive classroom-based instruction. For these students, parents must continue to provide immunization records to their schools and schools must continue to maintain and report records of immunizations. Students who have an individualized education program (IEP) should continue to receive all necessary services identified in their IEP regardless of their vaccination status.
Refer to Health and Safety Code sections and and SB 277 FAQs at
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