Connecticut State Department of Education, Connecticut Department of Health and the Darien Board of Education have specific health regulations students must adhere to while enrolled in Darien Public Schools.

New students will not be admitted until a school nurse has reviewed the student’s completed physical exam/health assessment and immunization records.  Students may be exempt from the State mandated immunization and physical examination requirements based on medical or religious grounds.

 

2012-2013 SCHEDULE OF REQUIRED PHYSICAL EXAMINATION / HEALTH ASESSESSMENT

SCHEDULE OF REQUIRED IMMUNIZATIONS

 

• New students entering Kindergarten through 12^th Grade must submit completed primary immunizations and physical examination/health assessment prior to school entrance.  The physical examination/health assessment should be documented on the State of Connecticut Department of Education Health Assessment Record (HAR-3 REV 4/2012) or its equivalent.

Please refer to the physical examination requirements document posted below for information and guidance for the physical examination requirements for new entrants into Darien Public School Kindergarten through grade 12.

 

• Pre-Kindergarten - Students entering pre-kindergarten must submit completed primary immunizations and physical examination / health assessment upon entry into the Early Learning Program and annually thereafter. A physical examination/health assessment for a new pre- kindergarten student is acceptable if it was completed within the year prior to entry. The physical examination/Health assessment must be dated no earlier than 365 days prior to school entrance. The physical examination/health assessment should be documented on the State of Connecticut Early Childhood Health Assessment Record (ED 191 REV 8/2011) or its equivalent.

 

• ALL Sixth Grade students PRIOR TO ENTRY INTO Seventh Grade must submit documentation of complete immunization update and physical examination / health assessment completed within 13 months prior to the start of seventh grade.

For the 2012-2013 school year:

• A student that is in the sixth grade during the 2012-2013 school year must submit documentation of complete immunization update and physical examination/health assessment completed within the 13 months prior to the start of seventh grade (August 26,2013). A physical examination/health assessment with complete immunization update will meet this requirement if completed on or after July 26, 2012. The documentation of complete immunization update and physical examination/health assessment must be submitted to school nurse prior to the student’s entry into seventh grade, August 26, 2013.

 

• ALL Ninth Grade students PRIOR TO ENTRY INTO Tenth Grade must submit documentation of complete immunization update and physical examination / health assessment completed within 13 months prior to the start of tenth grade.

 

For the 2012-2013 school year:

• A student that is in the ninth grade during the 2012-2013 school year must submit documentation of complete immunization update and physical examination/health assessment completed within the 13 months prior to the start of tenth grade.( August 26, 2013). A physical examination/health assessment with complete immunization update will meet this requirement if completed on or after July 26, 2012. The documentation of complete immunization update and physical examination/health assessment must be submitted to the school nurse prior to this student’s entry into tenth grade August 26, 2013.

• A student that was in the ninth grade during the 2011-2012 school year and is in tenth grade during the 2012-2013 school year-must submit documentation of complete immunization update and physical examination/health assessment if completed any date after July 26, 2011 The documentation of complete immunization update and physical examination/health assessment is due into the school nurse prior to this student’s entry into eleventh grade August 26, 2013.

 

Click here for:

Physical Examination Requirements

Physical Examination/Health Assessment Record Forms:

• State of Connecticut Department of Education Early Childhood Health Assessment Record
  For children ages birth - 5. (Pre-Kindergarten) (ED 191 Rev. 8/2011) 3 pages
  
• State of Connecticut Department of Education Health Assessment Record
  For Kindergarten through Grade 12^t (HAR-3 REV 4/2012) 3 pages

Immunization Requirement Information

Immunization Requirement Changes effective 8-1-11 for students entering K, Pre K and 7^th Grade 2011-2012

HIGH SCHOOL INTERSCHOLASTIC SPORTS PARTICIPATION HEALTH REQUIREMENTS

• State of CT Health Assessment Record

Student athletes participating in an interscholastic sport must, in accordance with CIAC rules and the Darien Board of Education, have an annual Physical Examination / Health Assessment which certifies the athlete may participate in athletic activities and competitive sports. This Physical Examination / Health Assessment must be current within 13 months of the beginning of tryouts, practice and competitive play, and be kept updated and on file with the school nurse. At no time shall an athlete be allowed to practice or compete if the date since the Physical Examination / Health Assessment exceeds 13 months. Even if the Physical Examination / Health Assessment was accepted at the beginning of the season, if during the season it becomes more than 13 months old, the athlete will not be allowed to continue to practice or play until a new Physical Examination / Health Assessment is on file with the school nurse. The physical examination/health assessment should be documented on the State of Connecticut Department of Education Health Assessment Record (HAR-3 REV 4/2012) (3 pages)

 

• DHS Coaches Athletic Emergency Form

Each sports season (fall, winter, spring) the student athlete and parent/guardian are required to complete and sign the DHS Coaches Athletic Emergency Form. Upon completion the student athlete needs to bring the DHS Coaches Athletic Emergency Form to the school nurse to verify medical clearance to participate in athletic activities and competitive sports. Then student athlete submits the DHS Coaches Athletic Emergency Form which has been reviewed and signed by the school nurse to the respective team coach. The DHS Coaches Athletic Emergency Form is then kept on file with the team coach for the duration of the team’s season.

 

PRE-KINDERGARTEN THROUGH GRADE 12-    Additional Health Forms and Information

Student Health Form Guidelines

Physical Activity Restriction Form

Authorization for Administration of Medicine Form

Health Screening Schedule *Please complete and return this form to school nurse if you do not want your child to participate in the DPS vision, hearing and postural screening program.

Request for HUSKY Health Insurance Form-English

Request for HUSKY Health Insurance Form-Spanish

DPS Health Services Contact Numbers

Community Pediatric Health Resources

Insect Allergy Forms

1. Parent Letter regarding Insect Allergies

2. Authorization for Administration of Medicine Form

3. Emergency Care Plan for Insect Allergies

4. Parent Authorization to Share Allergy Information

Food Allergy Forms

1. Parent Letter regarding Food Allergies

2. Authorization for Administration of Medicine Form

3. Emergency Care Plan for Food Allergies

4. Parent Authorization to Share Allergy Information

Exemption to School Immunization Requirements

1. Connecticut Department of Public Health Medical Exemption Certification Statement

2. Connecticut Department of Public Health Religious Exemption Certification Statement