Request for Immunization Records
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This request authorizes Rockwall ISD Health Services to provide a copy of immunization records. Any immunization records on file will be sent in the manner selected below. Former students who are 18 years or older must request their own immunization records. If you are requesting records during the school year for a current student, please contact their home campus.
1.
Students First Name While Attending School
*
2.
Students Middle Name While Attending School
*
3.
Students Last Name While Attending School
*
4.
Name of Last Rockwall ISD School Attended
*
--Please Select--
Rockwall High School
Rockwall-Heath High School
Quest Academy
Cain Middle School
Utley Middle School
Williams Middle School
Amanda Rochell Elemenaty
Amy-Parks Heath Elementary
Billie Stevenson Elementary
Celia Hays Elementary
Doris Cullins-Lake Pointe Elementary
Dorothy Smith Pullen Elementary
Dorris A. Jones Elementary
Grace Hartman Elementary
Howard Dobbs Elementary
Nebbie Williams Elementary
Ouida Springer Elementary
Sharon Shannon Elementary
Virginia Reinhardt Elementary
Linda Lyon Elementary
Sherry & Paul Hamm Elementary
Lupe Garcia Elementary
5.
Date of Birth
*
mm/dd/yyyy
6.
Phone
*
7.
Email
8.
Fax
9.
Please select the method you wish the records to be provided:
*
Email
Fax
10.
Typing your name below represents your digital signature which verifies that you have reviewed the above and that you certify that the information provided is true and accurate. I authorize Rockwall ISD Health Services to release the requested immunization records to the person named on this form. In compliance with the Family Education Rights and Privacy Act of 1974, I understand that without my signature on this form , my request cannot be processed. (Student Signature if over 18 years.)