School Health Admission and Annual Requirements

Please submit ONLY the Mid-Pacific Student Health Record. Please download this form and take it to your child's MD appointment. All other forms are not acceptable and will be returned.

If Your Child isNew TBNew Physical ExamComplete Immunization
A new student entering any grade. YES YES
(Also complete section "F" if they are in Athletics or Dance)
A rising 6th grader. YES YES
(Also complete section "F" if they are in Athletics)
A current student athlete in CSAL/Mid-Pacific/PAC 5 sports or the MPSA dance program. NO YES
(Section "F" required)
A rising 9th and 11th grader. NO YES NO

Please note: NEW means within 1 year prior to the first day of school at Mid-Pacific.

Submit completed Mid-Pacific Health form to Damon Hall (Grades 6-12) or Elementary School Main Office (grades Pre & 3-5) as soon as it is complete. Deadline is July 21st, but don't wait!

A note about TB Clearance: Mid Pacific requires a TB clearance be performed on ALL incoming students and ALL 6th graders. This test must be performed within a year prior to starting school that year. The state of Hawaii requires by law that all TB clearance must have a skin test documented. If the test is positive, an Xray will be necessary to provide clearance. An Xray without the skin test is not acceptable as TB clearance. This clearance must also be performed by a U.S. licensed practitioner only. No out of country TBs are acceptable.

Please be advised that the Health Department will only give one TB clearance per student so if your child has been cleared previously by the State Health Department and the clearance is older than one year, your child will need to get the Mid-Pacific admission TB clearance through your private MD.

Once your child has been cleared upon admission and 6th grade, they need no other TB clearance while enrolled at Mid-Pacific.

Immunization Requirements

Immunization Exemptions

At Mid-Pacific, we value our healthy school community and recognize the role vaccines play in continuing to protect and sustain a healthy school environment. Recent outbreaks of communicable diseases across the United States, including Hawaii, have coincided with the growing number of parents opting out of immunizing their children. These latest events have prompted us to re-evaluate our immunization exemption process.

Mid-Pacific, like all other Hawaii schools, is guided by the State of Hawaii laws and regulations. The State of Hawaii allows religious and medical exemptions only. No personal exemptions are permitted. Religious exemptions are accepted from members of "established" religions only. Medical exemptions are also accepted from the student's physician (MD or OD).

After careful consideration, Mid Pacific administration, in consultation with the school nurse and the Department of Health, is making the following clarifications to our exemption requirements:

Religious Exemption:

  • Parents of students with religious exemptions must complete the Mid-Pacific Religious Exemption form and have it notarized.
  • The form must be completed by the beginning of every school year but notarization is only required for the first year of enrollment.
  • This form must be on file with the school before the first day of school.

Medical Exemption:

  • Medical exemptions must be provided to the school by your child's primary physician.
  • It must be written on the physician's official letter head listing the medical condition exempting them from immunization, length of time the exemption is in place, signed and dated by the MD or OD. (Parental refusal of vaccines is not a medical exemption.)
  • This letter must be on file with the school before the first day of school.

Children who are given exemption status are at risk for being excluded from school for any report of an immunization-preventable disease in the school or in the community if deemed necessary by the Department of Health. They will be excluded until the incubation period of the last reported case is completed. This could be as long as 21 days after the LAST reported cases.

If your child has not completed the entire immunization program as defined by the State of Hawaii's Department of Health, please see your pediatrician to arrange for completion of these vaccines. We recognize this may take time. We encourage you to contact the school nurse directly, letting her know of your child's progress toward completing the required immunizations.

Keeping our school community healthy is a community effort. Keeping vaccine-preventable diseases out of our school isn't 100 percent possible, but vaccinations increase protection for the entire school. We recognize that some people hold differing beliefs regarding immunization and respect the rights of parents to make choices for their children. However, it is imperative that Mid-Pacific complies with the regulations set forth by the State.

Should you have any questions or concerns about the immunization exemption policy, kindly contact your child's principal. If you have questions about completing the immunization requirements, please contact the school nurse.