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Varicella (Chicken Pox) Form

Beginning in the school year 2011-2012, all students in the state of Nebraska must be immunized against varicella (chickenpox) with 2 doses of the vaccine.  If a student has had varicella, a signed statement (including year) must be provided to the school by the parent/guardian verifying a history of the disease.  A student who has had the disease does not need to be immunized.  If a student has not had varicella, documentation of when the vaccine was administered must be provided to the school.  Please complete the Varicella Form and return it to the school as soon as possible.   If you have any questions, please contact me at 988-2525 Ext. 137. Thank you for your cooperation.

Sherri Stanley, RN

Click Here to Access and Print the Varicella Form

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Freeman Public Schools415 8th StreetP.O. Box 259Adams, NE  68301

p. 402.988.2525f. 402.988.3475

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It is the policy of Freeman Public Schools not to discriminate on the basis of gender, disability, race, color, religion, marital status, age or national origin in its education programs, administration, policies, employment or other district programs.

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