• A current Kentucky State Immunization Certificate  must be on file at all times.  Additional immunizations are required at age 4.  If immunizations are declined, this Immunization Declination Form must be signed, notarized (with notary stamp), and returned to Care Clinic staff. 

• Proof of a physical exam completed on a Kentucky Preventative Health Care Examination form

• An eye exam completed by an ophthalmologist or optometrist, submitted on the Kentucky Vision Examination Form

KINDERGARTEN PARENT LETTER

• A current Kentucky State Immunization Certificate must be on file at all times.  If immunizations are declined, this Immunization Declination Form must be signed, notarized (with notary stamp), and returned to Care Clinic staff.   

• Proof of a physical exam completed on a Kentucky Preventative Health Care Examination form**

• An eye exam completed by an ophthalmologist or optometrist, submitted on the Kentucky Vision Examination Form**

• Proof of a dental screening/exam conducted by a dentist, dental hygienist, physician, registered nurse, nurse practitioner, or physician assistant. The screening/exam must be on the Kentucky Dental Screening/Examination Form.

** indicates the form is not required if previously submitted in preschool

• A current Kentucky State Immunization Certificate must be on file at all times. If immunizations are declined, this Immunization Declination Form must be signed, notarized (with notary stamp), and returned to Care Clinic staff. 

• An eye exam completed by an ophthalmologist or optometrist, submitted on the Kentucky Vision Examination Form (ages 5 & 6 only, if not previously submitted in preschool or kindergarten)

Proof of a dental screening/exam conducted by a dentist, dental hygienist, physician, registered nurse, nurse practitioner, or physician assistant. The screening/exam must be on the Kentucky Dental Screening/Examination Form (ages 5 & 6 only, if not previously submitted in kindergarten)

• A current Kentucky State Immunization Certificate must be on file at all times. Additional immunizations are required at age 16.  If immunizations are declined, this Immunization Declination Form must be signed, notarized (with notary stamp), and returned to Care Clinic staff.