Photo: Medical Forms 2013-14 School Year

Medical Forms 2013-14 School Year

Dear Parents, 

Welcome to Stephen S. Wise Temple Elementary School. At the bottom of this page you will find the medical forms required by the State of California for all students entering school.

Please have your child's physician complete these forms. These medical forms must be received by August 1, 2013. It is your responsibility to follow through with the doctor's office, ensuring that the School has received these forms.

Children entering Kindergarten through Sixth Grade are required to have:

• DPT, Polio and MMR boosters (see attached)
• Mantoux (PPD) within 1 year to the date of entering school
• Three doses of the Hepatitis B vaccine (K-5 only)
• Varicella or proof of chicken pox (K, 1 and 2 only)

These immunizations must be completed, and proof of same received by the school, NO LATER THAN AUGUST 1, 2013. State law requires that these forms are on file for each child before he or she is able to start school. If these documents are not received by August 1, 2013, your child will not be able to attend the first day of school. Children MUST be protected before they enter school. Should you have questions please contact me at 310.889.2212. You may fax the completed forms to 424.270.2356 or send to the Elementary School Office.


Carol Vinstein, R.N., M.S.N.
School Nurse



Completed forms can be mailed to:

Stephen S. Wise Temple Elementary
15500 Stephen S. Wise Drive
Los Angeles, CA 90077-1520
Attn: School Nurse 

Required forms for new students to Wise Elementary (Including Kindergarten)

Required forms for all students (Including new students to Wise Elementary)

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