Annual Physical and Immunization Records Annual Physical Form and Immunization Records To be completed by the child's doctor's office Physician Use OnlyThe City of Dallas Health Department, which inspects our school periodically, requires that a Health Form be on file in the school for each student. Please bring this form with you to your child’s annual physical during the summer and have current immunization records printed for their school file. Student's Name* First Last Your Email Address* * I certify that the student named above is free of infectious and contagious diseases, and is physically and mentally able to participate in group activities. Please upload a copy of the child's current Immunization RecordsYou may also fax, email, or mail the child's Immunization Records to: Fax: 214-324-5671 Email: firstname.lastname@example.org Mail: 1601 Oates Drive, Dallas, Texas 75228Hearing Test Results (if available)Vision Test Results (if available)Scoliosis Test Results (if available)Electronic SignatureElectronic Signature* First Last I warrant the truthfulness of the information provided in this form.* I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above terms.