ImmunizationForm

ImmunizationForm - IMMUNIZATION STATUS (Important, please...

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IMMUNIZATION STATUS (Important, please read carefully) To all incoming students: A complete report of your Immunization status is mandatory in order to register at Whitworth. This policy is in place for the protection of the university community. University students are at greater risk for contracting a variety of diseases. If you do not have recommended protection during an outbreak, you would be asked to leave campus. The vaccines listed below are recommended by the ACIP (American Counsel on Immunization Practices) www.cdc.gov/nip/ACIP/default.htm and ACHA (American University Health Association) www.acha.org for all students. NAME: BIRTHDATE: AGE: SEX:(Select One) SPORT 1: (select sport) SPORT 2: (select sport) IMMUNIZATION RECORD: This record becomes part of your permanent medical chart and will be updated with any vaccines received at the Health Center. *Starred vaccines are available at Whitworth Health Center. Childhood DPT series of 4. (Diphtheria, Pertussis, Tetanus)
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