Hampton-Dumont Community School District

Please check the chart at the bottom of the page to verify which vaccinations your child will need for the upcoming school year. All health documents must be returned to the District Nurse prior to the first day of school by mail, email, or fax to the appropriate building.

Immunization is not required for a person’s enrollment in any elementary or secondary school or licensed child care center if either of the following applies: 

(1) The applicant, or if the applicant is a minor, the applicant’s parent or legal guardian, submits to the admitting official a statement signed by a physician, advanced registered nurse practitioner, or physician assistant who is licensed by the board of medicine, board of nursing, or board of physician assistants that the immunizations required would be injurious to the health and well-being of the applicant or any member of the applicant’s family. Families can complete the Medical Certificate of Immunization Exemption and submit to the District Nurse.

(2) The applicant, or if the applicant is a minor, the applicant’s parent or legal guardian, submits an affidavit signed by the applicant, or if the applicant is a minor, the applicant’s parent or legal guardian, stating that the immunization conflicts with the tenets and practices of a recognized religious denomination of which the applicant is an adherent or member. Families can complete the Religious Certificate of Immunization Exemption and submit to the District Nurse.

Please contact your health care provider with any questions regarding these state health requirements.

• Vision Screening Form (Required for Kindergarten and 3rd grade)
• Dental Screening Form (Required for Kindergarten and 9th grade)
• Immunization Certificate (Required for Preschool, Kindergarten, 7th and 12th grade)
• Lead Screening (Required for Kindergarten. There is no form available, but it will be cross referenced with your healthcare provider)
• Preschool & Kindergarten Physical Form (Required for Preschool & Kindergarten)
• Physical Form (Required for all 7-12th grade athletes)
• Diet Modification Request Form (Optional; As needed based on dietary needs)

Does your child need to take medication during the school day? Please complete the Authorization to Administer Medication Form and return to the District Nurse prior to the first day of school.