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Chaparral - 7th Grade Immunization Record

CHAPARRAL MIDDLE SCHOOL
Incoming 7th Graders
Immunization Requirement

If you are an incoming 7th grade student and have not submitted your updated immunization record, please complete the form below. Required fields marked with an asterisk *

For more information about immunization requirements, please visit: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/School/tk-12-immunizations.aspx

The website containts specific sections pertinent to incoming 7th graders.

You may also turn the immunization record directly into the office during school hours. By submitting and clearing your immunization record online or in-person, your wait time during registration in August will be significantly reduced.

Student Information

First Name*

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Student ID Number*

Answer required for "Student ID Number"

Student Date of Birth*

Answer required for "Student Date of Birth"

Parent / Guardian Information

Parent Name*

Must match name listed in Aeries

Answer required for "Parent Name"

Parent Contact Number

Must match contact number on file in Aeries

Number Required

Parent Email

Must match email address on file in Aeries

Answer required for "Parent Email"

Immunization Records

Submit your child's immunization record*

PDF (preferred), JPG, DOC

Answer required for "Submit your child's immunization record"

Choose a file or drag it here.

Signature*

Signature Required

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"