Immunization Forms

How & WHen to submit immunization records

All children must have immunization records up to date and on record at school before they start class. Please submit complete immunization records as soon as possible after registering and before your child's first day of school.

There are a few ways to get your child's immunization records:

  • Obtain a copy from your child's clinic.

  • Fill out the form below (MDH Immunization Record Form, also available on the web here) and submit to us

  • Visit the Minnesota Immunization Information Connection (MIIC)

There are also multiple ways you can submit your child's immunization record!

  • Drop the record off at your child's school or the Welcome Center (8100 School Road, Eden Prairie)

  • Fax (or have your clinic fax) the record to us (attention Health Services):

    • Lower Campus: 952-975-7221

    • Education Center: 952-975-6920

  • Email the record to autumn_lovas@edenpr.k12.mn.us or to

  • Mail the record to:

Community Education

Attn: Health Services

8040 Mitchell Road

Eden Prairie, MN 55344


PLEASE INCLUDE YOUR CHILD'S FULL NAME AND DATE OF BIRTH ON ALL DOCUMENTS!


MDH_imzform.pdf

Exemptions to Routine Immunization Requirements

Minnesota Law allows for 2 exemptions from immunization requirement for school. If one of these exemptions apply to your child, you can submit the exemptions by completing the appropriate box in the form above.

  1. Medical exemptions: these are used when a child has a medical reason to not receive a certain vaccine. For example, children with certain medical conditions cannot receive some vaccines, some have laboratory confirmation that they are already immune to some illnesses, or in the case of varicella, a health care provider confirms previous diagnosis of chickenpox with current presumed immunity.

    1. To complete a medical exemption, mark the box(s) corresponding to the vaccine(s) that are medically exempt and obtain the signature of your child's health care provider.

  2. Non-medical exemptions (sometimes referred to as conscientious objection) allow parents or guardians to choose not to vaccinate if doing so is against their beliefs.

    1. To complete a non-medical exemption, please complete Box 1B, including notarization.

Exemption forms, if appropriate, are part of the complete immunization record. Please submit these forms prior to your child's first day of school