Information Necessary for Pupil Enrollment in Public Schools

(From the Virginia Department of Education (VDOE) and Dinwiddie County Public Schools Division Policies)

In order to enroll a child in a public school system in Virginia, state law requires a parent or guardian of a child to provide certain information to the child’s school division. The required information is listed below.

Registration Form

All student enrolling in Dinwiddie County Public Schools need to have the following registration form completed, which includes information such as the child’s name, date of birth, social security number, address, and parent/guardian information among other things.

K-12 Registration Form

Formlario de Matrícula K-12

If a court has awarded you legal parental custody of your child, you must attach a copy of the Custody Order including the visitation rights during the day.

Birth Certificate

An official certified copy of the child’s birth record must be provided (A photocopy of the child’s birth certificate will not meet this requirement.). Information on obtaining a certified copy of a birth certification is available at the Virginia Department of Health website.

At the time of enrollment, the child must be five years of age or reach his/her fifth birthday on or before September 30th of the current school year.

If a certified copy of the child’s birth record cannot be obtained, the person enrolling the child must submit a sworn statement setting forth the child’s age and explaining the inability to present a certified copy of the birth record.

School Entrance Health Form

A School Entrance Health Form, MCH 213G, completed by a licensed physician, licensed nurse practitioner, or licensed physician’s assistant regarding the child, must be presented at the time of enrollment. The three-part form includes Part I-Health Information Form, Part II Certification of Immunization, and Part III-Comprehensive Physical Examination Report. The report must indicate that the child has received a comprehensive physical examination performed within the twelve months prior to the date the child first enters a public kindergarten or elementary school (K-5). The physical examination report must include “Recommendations to School” and other information as required by school division policy.

The health departments of all the counties and cities must provide the physical examination for medically indigent children without charge, upon request.

The Comprehensive Physical Examination is not required of any child if it violates the family’s religious beliefs and the child’s parent or guardian states in writing that the child is free from any communicable or contagious disease and there is no visual evidence of sickness.

School Entrance Physical Exam Form

Instruction on VDOE Site


Documentation (Part II of the School Entrance Health Form MCH 213F) indicating that the child has received the required immunizations must be provided. The required immunizations include:

  • Diphtheria, Tetanus, & Pertussis (DTaP, DTP) – A minimum of 4 doses. A child must have at least one dose of DTaP or DTP vaccine on or after the fourth birthday.
  • Hepatitis B Vaccine – A complete series of 3 doses of hepatitis B vaccine is required for all children. However, the FDA has approved a 2-dose schedule ONLY for adolescents 11-15 years of age AND ONLY when the Merck Brand (RECOMBIVAX HB) Adult Formulation Hepatitis B Vaccine is used.
  • Human Papillomavirus Vaccine (HPV) – Effective October 1, 2008, a complete series of 3 doses of HPV vaccine is required for females. The first dose shall be administered before the child enters the 6th grade. After reviewing educational materials approved by the Board of Health, the parent or guardian, at the parent’s or guardian’s sole discretion, may elect for the child not to receive the HPV vaccine.
  • Measles, Mumps, & Rubella (MMR) Vaccine – A minimum of 2 measles, 2 mumps, and 1 rubella. (Most children receive 2 doses of each because the vaccine usually administered is the combination vaccine MMR). First dose must be administered at age 12 months or older. Second dose of vaccine must be administered prior to entering kindergarten but can be administered at any time after the minimum interval between dose 1 and dose 2.
  • Polio Vaccine – A minimum of 4 doses of polio vaccine. One dose must be administered on or after the fourth birthday.
  • Tetanus, Diphtheria, & Acellular Pertussis (Tdap) – A booster dose of Tdap vaccine is required for all children entering the 6th grade, if at least five years have passed since the last dose of tetanus-containing vaccine.
  • Varicella (Chickenpox) Vaccine – All susceptible children born on and after January 1, 1997, shall be required to have one dose of chickenpox vaccine administered at age 12 months or older. Effective March 3, 2010, a second dose must be administered prior to entering kindergarten but can be administered at any time after the minimum interval between dose 1 and dose 2.

Minimum Immunizations Requirements for Entry Into Child Care and School

Any child whose immunizations are incomplete may be admitted conditionally, if the parent or guardian provides documentation at the time of enrollment, that the child has received at least one dose of the required immunizations and has a written schedule for completing the remaining doses within 90 days.

No certificate of immunization shall be required for the admission to school of any student if (i) the student or his parent submits an affidavit to the admitting official stating that the administration of immunizing agents conflicts with the student’s religious tenets or practices; or (ii) the school has written certification from a licensed physician or a local health department that one or more of the required immunizations may be detrimental to the student’s health, indicating the specific nature and probable duration of the medical condition or circumstance that contraindicates immunization.

Proof of Residency

If a child has no regular, fixed residence but resides within the school division in a temporary shelter, institution, or place not ordinarily used as a residence, the school division may determine that a street address, route number, or post office box number, cannot be provided. The school division may accept an alternative form of address that it considers appropriate. Please speak with the school counselor for more information.

Proof of Residency Form (PDF)

Parent or Guardian Proof of Residency Chart & Checklist (PDF)

Emergency Health Information

Students with mild to severe health care needs or medical conditions are required to have an Emergency Care Plan (ECP) on file. The ECP helps assure consistent, safe health care for the student, and provides documentation regarding the extent of services provided. Please have the forms completed and returned to your child’s school, if needed.

Emergency Care Plan Forms

Treatment Authorization Form (PDF)

Medication Authorization Form (PDF)

Pre-Kindergarten Experience Form

(Kindergarten students only)

The Department of Education is collection data related to pre-kindergarten experiences for incoming kindergarten students in our Commonwealth. Please complete the following form if you are enrolling your student in kindergarten.

Pre-Kindergarten Experience Form (PDF)