Admission Forms

Dear Parent or Guardian:

Welcome to Kindergarten Orientation! My name is Gina Vieira; I am the School Nurse for New Jerusalem School District and Delta Charter Schools. I would like to take this opportunity to welcome you to our district and to inform you of the health related requirements your child will need prior to starting school. If you have any questions about these requirements, please let me know.  California law requires schools to maintain the privacy of students’ health information. Your child’s identity will not be associated withany report produced as a result of these requirements. 


  1. Oral Health Assessment: To make sure your child is ready for school, California law requires that your child have an oral health assessment (dental check-up).  Assessments that have happened within 12 monthsbefore your child enters school also meet this requirement. The law specifies that the assessment must be done by a licensed dentist or other licensed or registered dental health professional. (Education Code Section 49452.8)


  2. Report of Health Examination for School Entry (also referred to as a physical assessment): To protect the health of children, California law requires a health examination on school entry, and can be done up to six months prior to the start of school. This form is filled out by a health examiner i.e. physician, physician’s assistant or nurse practitioner, and returned to the school.  It is highly suggested that this form be taken with the child when kindergarten immunizations are received, so that additional visits to the doctor are avoided.  (Health and Safety Code 124040, 124085)


  3. Immunization Schedule: The following immunizations are required of all students entering Kindergarten and must be presented at the time of registration. Please note: Personal Beliefs Exemptions , including Religious Beliefs, will no longer be accepted (Senate Bill 277).


Polio : 4 doses at any age, but... 3 doses meet requirement for ages 4-6

if at least one was given on or after the 4th birthday

Diphtheria, Tetanus, and Pertussis: 5 doses at any age, but... 4 doses meet requirements for ages 4-6 if at least one was on or after the 4th birthday.

Measles, Mumps, Rubella (MMR): 2 doses after 1st birthday.

Hepatitis B: 3 doses at any age

Varicella: 1 dose or health care provider-documented varicella disease or immunity


If your child’s immunization record is not up to date, the registration packet will be considered incomplete, and will not be accepted at that time. If your child has a diagnosed MEDICAL CONDITION for which immunizations are contraindicated, please contact your doctor to obtain a temporary or permanent medical exemption.  Please notify the school if your child will be under the care of a physician and is not able to be immunized.


I hope you and your child are excited about entering Kindergarten! If you have any health related questions, please feel free to contact me at your convenience.  I can be reached at 209-362-0586.



Gina Vieira, RN

 Gina Vieira, RN

School Nurse

New Jerusalem School District and Delta Charter Schools