Care of Students with Food Allergies At-Risk for Anaphylaxis

Immunization Requirements

Minimum Immunization Requirements for K-12 (English & Spanish)

Please turn updated shot records in to the front office or have a copy faxed to


A student must be fully immunized against certain diseases or must present a certificate that, from medical, religious, or reasons of conscience, the student should not be immunized.


Exclusions from compliance are allowable on an individual basis for medical contraindications, reasons of conscience, including a religious belief, and active duty with the armed forces of the United States. Children and students in these categories must submit evidence for exclusion from compliance as specified in the Health and Safety Code, §161.004(d), Health and Safety Code, §161.0041, Education Code, Chapter 38, Education Code, Chapter 51, and the Human Resources Code, Chapter 42.


If a student should not be immunized for medical reasons, the student or parent must present certificate signed by a U.S. licensed physician that, in the doctor’s opinion, the immunization required would be harmful to the health and well-being of the student or any member of the student’s family or household. This certificate must be renewed yearly unless the physician specifies a life-long contraindication.


If a student ‘s religious beliefs conflict with requirement that the student be immunized, the student must present a statement signed by the student (or by the parent if the student is a minor) that states that immunization conflicts with the beliefs and practices of a recognized church or religious denomination of which the student is an adherent or member. This statement must be renewed yearly.


 To claim an exclusion for reasons of conscience, including a religious belief, the child's parent, legal guardian, or a student 18 years of age or older must present to the school or child-care facility a completed, signed and notarized affidavit on a form provided by the department stating that the child's parent, legal guardian, or the student declines vaccinations for reasons of conscience, including because of the person's religious beliefs. The affidavit will be valid for a two-year period from the date of notarization.


A person claiming exclusion for reasons of conscience, including a religious belief, from a required immunization may only obtain the affidavit form by submitting a request (via online, fax, mail, or hand-delivery) to the department. The request must include the following information:

(i)            full name of child or student;

(ii)          child's or student's date of birth (month/day/year);

(iii)         complete mailing address, including telephone number; and

(iv)         number of requested affidavit forms (not to exceed 5).


Requests for affidavit forms must be submitted to the department through one of the following methods:

(i)            written request through the United States Postal Service (or other commercial carrier) to the department at: DSHS Immunization Branch, Mail code 1946, P.O. Box 149347, Austin, Texas 78714-9347;

(ii)          by facsimile to (512) 776-7544;

(iii)         by hand-delivery to the department's physical address at 1100 West 49th Street, Austin, Texas 78756; or

(iv)         via the department's Immunization program website (at

The department will mail the requested affidavit form(s) (not to exceed five forms per child or student) to the specified mailing address.


To claim an exclusion for armed forces, persons who can prove that they are serving on active duty with the armed forces of the United States are exempted from the requirements in these sections.


A child or student, who has not received the required immunizations for reasons of conscience, including religious beliefs, may be excluded from school in times of emergency or epidemic declared by the commissioner of the department.


The immunizations required are: diphtheria, tetanus, polio, measles (rubella), mumps and influenza; the Charter school can provide information on age-appropriate doses or on an acceptable physician-validated history of illness required by the Texas Department of health. Proof of immunization maybe personal records from a licensed physician or public health clinic with a signature or rubber-stamp validation.



© 2005, ComQuest Academy Charter High School