View important information about health exams, immunizations

Parents/guardians: Please note the following important information:

Health exams

New York State law requires a health examination for all students entering the school district for the first time and when entering Pre-K or K, 2nd, 4th, 7th, and 10th grade. The examination must be completed by a New York State licensed physician, physician assistant or nurse practitioner.

IF YOU WOULD LIKE YOUR CHILD TO HAVE A PHYSICAL AT SCHOOL WITH OUR NURSE PRACTITIONER, please return the form e-mailed to you or contact School Nurse Nancy Ellefsen at 815-615-6314 or

A copy of the health examination must be provided to the school within 30 days from when your child first starts at the school, and when your child starts K, 2nd, 4th, 7th, & 10th grades. If a copy is not given to the school within 30 days, the school will contact you.

If your child has an appointment for an exam during this school year that is after the first 30 days of school, please notify the Health Office with the date.

For your convenience, a physical exam form and dental certificate for your health care providers is enclosed.

Communication between private and school health staff is important for safe and effective care at school. Your healthcare provider may not share health information with school health staff without your signed permission. Please talk to your provider about signing their consent form for the school at the time of your child’s appointment for the examination.
We suggest you make copies of the completed forms for your own records before sending them to the school health office. Forms may also be faxed to School Nurse Nancy Ellefsen at 845-615-6314.


New York State Law Section 2164 requires certain immunizations (shots) to enter and attend school. Please check with your health care provider as soon as possible to make sure that your child has all the needed immunizations. They are listed below:

  • DTaP/DTP – 3 doses
  • Tdap – Age 11: Must receive an immunization containing Tetanus, Toxoids, diphtheria, and acellular pertussis (Tdap)
  • Polio – 4 doses or 3 doses if the third dose was received at age 4 or older
  • MMR – 2 doses
  • Hepatitis B – 3 doses or 2 doses of adult hepatitis B Vaccine (RECOMBIVAX HB)
  • Varicella (Chickenpox) – 2 doses
  • Meningococcal conjugate (MenACWY) – 1 dose grades 7 & 8*

* The meningococcal requirement moves up a grade, so students in grades 7 and 8 are required to have received MenACWY vaccine. Grade 8 should only be students from out of state or country and any students who didn’t receive the vaccine in grade 7. Most of the students in grade 8 will have already received the dose in grade 7. Learn more about the meningococcal vaccine requirement.

Thank you for your attention to these new immunization requirements. If you have questions or concerns about immunizations, please contact the school health staff:

Scotchtown Avenue Elementary School

Suzanne Dombrowski
(845) 615-6617

Goshen Intermediate School

Charlotte O’Connor
(845) 615-6525

C. J. Hooker Middle School

Nancy Moore-Ellefsen
(845) 615-6314

Goshen High School

Toni Samuelson
(845) 615-6133