Can parents opt out of daycare immunization requirements?

Exemption policies differ significantly by state. Most states allow medical exemptions when a licensed physician certifies that immunization would be medically contraindicated for a specific child. Many states also allow religious exemptions, and some states permit personal or philosophical belief exemptions. However, several states have tightened their exemption rules in recent years and no longer allow non-medical exemptions. Exemption rules can change by legislative action and vary at the county level in some states. This page reflects general information about childcare licensing requirements — verify your state's current exemption rules with your state health department or licensing office before enrolling a child.

Do daycare staff need vaccines too?

Some states require licensed childcare staff to be current on certain immunizations as a condition of employment or facility licensure. Common staff requirements include annual influenza vaccination, Tdap (Tetanus, Diphtheria, Pertussis booster), MMR, and Varicella. Staff requirements are typically set in the same licensing rules as child requirements. Contact your state's childcare licensing agency for the staff-specific vaccination requirements that apply to your program.

Are immunization records required for enrollment?

Yes, in virtually all states. Licensed childcare facilities are generally required to collect and keep on file a current immunization record for each enrolled child before or within a short period after enrollment. The required documentation is typically a copy of the child's official immunization record as provided by a healthcare provider. Facilities may also be required to submit aggregate immunization data to the state as part of annual licensing compliance. Check your state's licensing rules for the specific documentation and retention requirements.

50-State Data Reference

Daycare Immunization Requirements by State (2026)

Name: Daycare Immunization Requirements by U.S. State (2026)
Creator: TotReady Research Team
License: https://totready.com/terms

Which vaccines does your state require for childcare enrollment? This page lists the immunizations required under childcare licensing rules for all 50 states. Requirements are set by each state's childcare licensing agency — not the CDC — and vary in number, exemption rules, and documentation format.

Important: This is general information about state childcare licensing requirements, not medical advice. Immunization schedules change — verify the current required schedule with your state health department and your pediatrician before making any health decisions.

Last updated: June 2026

Compiled by the TotReady Research Team from published state childcare licensing rules

Key finding: The vaccines most commonly required across all 50 states for daycare enrollment are DTaP, Polio, MMR, Varicella, Hib, and Hepatitis B. Many states additionally require Hepatitis A and Pneumococcal. TotReady has confirmed immunization requirements for 50 of 50 states from published state childcare licensing rules.

Required Immunizations, State by State

Each entry lists the vaccines required under that state's childcare licensing rules for enrolled children. This reflects childcare licensing requirements, not the full CDC-recommended immunization schedule. Always verify the current required schedule and acceptable documentation with your state health department.

Alabama

Required vaccines: On the child's first day of attendance, each child from 2 months of age to lawful school age (and each child of lawful school age not enrolled in public/private school kindergarten) must have a valid State of Alabama Certificate of Immunization on file in the center (660-5-26-.08(4)(b)3), Each child's Certificate of Immunization must be kept current and updated according to the expiration date indicated on the certificate, Acceptable in lieu of immunization: a valid State of Alabama Certificate of Medical Exemption, Acceptable in lieu of immunization: a valid Alabama Certificate of Religious Exemption, Children meeting the definition of homelessness under the McKinney-Vento Homeless Assistance Act are excepted (current codified version of 660-5-26-.08(4)(b)3), The underlying immunization schedule and certificate are issued by the Alabama Department of Public Health (ADPH); the day care licensing rule requires the ADPH-issued State of Alabama Certificate of Immunization but does not name a specific form number (e.g., IMM 50).

Alaska

Required vaccines: Before admission, the facility must obtain from the parent a valid immunization certificate or evidence the child is exempt (7 AAC 57.550(a)), Acceptable documentation: the child's original immunization record or a physician/provider-documented record showing the dates each required immunization was administered (7 AAC 57.550(b)), Required immunizations follow the Alaska childhood immunization schedule (e.g., DTaP/Tdap, polio/IPV, MMR, Hib, hepatitis B, varicella, pneumococcal/PCV) per the Alaska Division of Public Health childhood schedule, Exemptions permitted: medical exemption, religious exemption, and provisional/temporary exemption for homeless or foster children lacking records (7 AAC 57.550(c)); provisional 30-day enrollment for children lacking available records (7 AAC 57.550(k)); up to 60-day provisional admission in medically underserved communities (7 AAC 57.550(e)).

Arizona

Required vaccines: DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A.

Arkansas

Required vaccines: Children must have an authorized record of up-to-date immunizations per the current Arkansas Department of Health (ADH) immunization schedule (MLR Section 604, item h); documentation of a religious or medical exemption is accepted in lieu of records., DTaP/DTP/DT (diphtheria, tetanus, pertussis) — per ADH schedule by age, Polio (IPV), Hib (Haemophilus influenzae type b), Hepatitis B, MMR (measles, mumps, rubella), Varicella (chickenpox), Pneumococcal (PCV), Note: the specific antigen list and schedule are set by ADH (Arkansas Department of Health) rules, not by the MLR; the MLR only requires an 'authorized record of up-to-date immunizations.' Treat the antigen list as the ADH schedule, not as an MLR enumeration..

California

Required vaccines: DTaP (Diphtheria, Tetanus, Pertussis), Polio, Hib (Haemophilus influenzae type b), Hepatitis B, MMR (Measles, Mumps, Rubella), Varicella, Hepatitis A (required since 2018).

Colorado

Required vaccines: Up-to-date school-required immunizations documented on the CDPHE Certificate of Immunization (or an approved exemption certificate) per Colorado Board of Health rules at 6 CCR 1009-2, on or before the first day of admission (8 CCR 1402-1, Rule 2.219(B)(1)), Standard CDPHE-required vaccines for child care/school entry include DTaP, polio (IPV), MMR (measles/mumps/rubella), hepatitis B, and varicella (chickenpox); plus Hib and pneumococcal (PCV) for younger children, Medical exemption: CDPHE Certificate of Medical Exemption signed by an immunizing provider, Nonmedical (religious/personal-belief) exemption: CDPHE Certificate of Nonmedical Exemption obtained either with an immunizing provider's signature or by completing the CDPHE Online Immunization Education Module (6 CCR 1009-2).

Connecticut

Required vaccines: DTaP (diphtheria, tetanus, acellular pertussis), Hib (Haemophilus influenzae type b), Pneumococcal conjugate (PCV), Polio (IPV), MMR (measles, mumps, rubella), Hepatitis B, Hepatitis A (2 doses given six calendar months apart, 1st dose on or after the 1st birthday — required for child care/preschool), Varicella (chickenpox), Influenza (1 dose required each year between Aug 1 and Dec 31 for preschool-age children; NOT required once a child turns 5).

Delaware

Required vaccines: Age-appropriate immunizations as required by 14 DE Admin. Code 933 §41.1.4 and detailed in DELACARE Appendix IV (Immunizations), which follows the CDC/ACIP childhood schedule, DTaP/DT (diphtheria, tetanus, pertussis), Polio (IPV), MMR (measles, mumps, rubella), Varicella (chickenpox), Haemophilus influenzae type b (Hib), Hepatitis B, Pneumococcal conjugate (PCV), Health appraisal updated every 13 months (§41.1); proof of blood lead test required for children ages 12 months and older (§41.1.5), Religious or medical exemption permitted with a notarized statement or health-care-provider documentation (§41.3).

Florida

Required vaccines: DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal.

Georgia

Required vaccines: DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal.

Hawaii

Required vaccines: Governed by HAR Title 11 Chapter 157 (Dept. of Health — Examination and Immunization Requirements); updates effective July 1, 2020; documented on a DOH-approved form (DOE Form 14), For children aged 2 years and older (the GCCH age range): DTaP — 4 doses, Hib (Haemophilus influenzae type b) — 3 to 4 doses (age-dependent), Hepatitis A — 2 doses, Hepatitis B — 3 doses, MMR (measles, mumps, rubella) — 1 dose, PCV (pneumococcal conjugate) — 4 doses, Polio (IPV) — 3 doses, Varicella (chickenpox) — 1 dose (documented history of disease signed by a practitioner may substitute), For children younger than 2 years, the number of required doses depends on the child's age (per HAR 11-157 Immunization Requirements Summary, Table 1), Physical examination within 12 months before first attendance, signed by a licensed practitioner (physician, APRN, or physician assistant), Serologic (lab) evidence of immunity may substitute for an immunization record for certain diseases, Medical and religious exemptions available with appropriate documentation.

Idaho

Required vaccines: Diphtheria, Tetanus and Acellular Pertussis (DTaP), Polio (IPV), Measles, Mumps, and Rubella (MMR), Haemophilus Influenzae Type B (Hib), Hepatitis B, Varicella (chickenpox), Pneumococcal, Rotavirus, Hepatitis A, Per Idaho Code § 39-1118: immunization record due within 14 days of a child's initial attendance; medical exemption (physician certificate) and religious/other-grounds exemption (signed statement) allowed; non-compliant children excluded by the operator until in compliance, and exempt children may be excluded during a disease outbreak; Department compliance inspections authorized with 30 days' notice (§ 39-1118(5)). Detailed schedule set by IDAPA 16.02.11 (Immunization Requirements for Licensed Daycare Facility Attendees), cross-referenced in IDAPA 16.06.03.380.22.

Illinois

Required vaccines: DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal.

Indiana

Required vaccines: Documentation of complete age-appropriate immunizations as required by FSSA/the division with recommendation from the Indiana State Department of Health (ISDH/IDOH), updated annually (470 IAC 3-4.7-86; IC 12-17.2-4-18.1), Conjugated pneumococcal vaccine (PCV) - statutorily required under IC 12-17.2-4-18.1, Varicella (chickenpox) vaccine, or demonstrated immunity to varicella - statutorily required under IC 12-17.2-4-18.1 (also 470 IAC 3-4.7-86), Other age-appropriate immunizations per the ISDH schedule (e.g., DTaP, IPV polio, MMR, Hib, Hepatitis B; specific antigens beyond PCV and varicella are set by ISDH schedule rather than named in statute), Medical exemption: child's physician indicates and updates the exception annually on the child's health record (470 IAC 3-4.7-86; IC 12-17.2-4-18.1), Religious exemption: parent submits a signed written request based on religious beliefs, kept in the child's health record (470 IAC 3-4.7-86; IC 12-17.2-4-18.1), Exemptions do not prevent the center from using emergency first aid or excluding a child when communicable disease control is necessary (470 IAC 3-4.7-86), Written verification of a physical examination by a physician/qualified provider within 30 days after enrollment, or no earlier than 12 months prior to enrollment (470 IAC 3-4.7-86).

Iowa

Required vaccines: Diphtheria, tetanus, pertussis (DTaP), Poliomyelitis (IPV), Measles, mumps, rubella (MMR), Varicella (chickenpox), Haemophilus influenzae type b (Hib), Pneumococcal conjugate (PCV), Hepatitis B, Required for children enrolled or attempting to enroll in a licensed child care center per Iowa Admin. Code ch. 641-7 and Iowa Code 139A.8; medical and religious exemptions allowed with a valid department Certificate of Immunization Exemption per 641-7.3. Specific dose counts and age cutoffs (e.g., Hib/PCV age limits; Hepatitis B for children born on/after July 1, 1994) follow the Iowa HHS immunization requirements chart and were not individually re-verified in this pass..

Kansas

Required vaccines: Diphtheria, tetanus, and pertussis (DTaP), Poliomyelitis (polio), Measles, mumps, and rubella (MMR), Hepatitis B, Hepatitis A, Varicella (chickenpox), Haemophilus influenzae type B (Hib), Pneumococcal disease (PCV), Required current and age-appropriate for child care/preschool per K.A.R. 28-1-20(d); immunization records maintained on each child's medical record per K.A.R. 28-4-430(a)(5); exceptions permitted for medical reasons (certification from a licensed physician) or religious reasons per K.S.A. 65-508(h) (cross-referenced for child care by K.A.R. 28-4-430(a)(6)).

Kentucky

Required vaccines: Current Commonwealth of Kentucky Certificate of Immunization Status required to attend a child-care center, certified family child-care home, or other licensed facility, beginning at age 3 months (902 KAR 2:060), Hepatitis B (HepB), Diphtheria, Tetanus, acellular Pertussis (DTaP/DTP), Poliovirus (IPV/OPV), Haemophilus influenzae type b (Hib), Pneumococcal conjugate (PCV), Measles, Mumps, Rubella (MMR), Varicella (chickenpox), Hepatitis A (HepA), Medical exemption via Certificate marked to designate a medical contraindication; religious exemption via the notarized Declination on Religious Grounds form (902 KAR 2:060).

Louisiana

Required vaccines: Required under La. R.S. 17:170: proof of immunization (or program in progress) presented at entry; chief administrators of licensed daycare centers must check records and enforce compliance, Diphtheria, Tetanus, Pertussis (DTaP), Poliomyelitis (IPV/polio), Measles, Mumps, Rubella (MMR), Hepatitis B, Varicella (chickenpox), Haemophilus influenzae Type B (Hib) - for children under 4 in Pre-K/Daycare/Head Start, Pneumococcal Conjugate (PCV) and Rotavirus - for children under 4 in Pre-K/Daycare/Head Start, Immunization schedule set by the LA Department of Health (LDH) Office of Public Health (LAC Title 51, Part II, §701), Centers must make parents aware of influenza immunization information by November 1 of each year (§1915).

Maine

Required vaccines: Measles, Mumps, Rubella, Diphtheria, Pertussis, Polio, Tetanus, Haemophilus influenzae Type b (Hib), Varicella (chickenpox), Hepatitis B, Pneumococcal conjugate (PCV).

Maryland

Required vaccines: DTaP/DTP (diphtheria, tetanus, pertussis), Polio (IPV), MMR (measles, mumps, rubella) — doses on or after first birthday, Hib (Haemophilus influenzae type b) — required through 59 months of age, PCV (pneumococcal conjugate / Prevnar) — required through 59 months of age, Hepatitis B, Varicella (chickenpox) — doses on or after first birthday, Documentation required on Maryland Department of Health Immunization Certificate (MDH Form 896). COMAR 13A.16.03.04 (Child Records) requires the operator to obtain and maintain an immunization record showing the child has age-appropriate immunizations meeting Maryland Department of Health guidelines; temporary/provisional admission pending immunization is addressed in COMAR 13A.16.03.02 F. Medical and religious exemptions are recognized., Blood lead screening / test verification required for children under 6 years old (COMAR 13A.16.03.02 E).

Massachusetts

Required vaccines: DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal, Meningococcal, Influenza.

Michigan

Required vaccines: DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal.

Minnesota

Required vaccines: Diphtheria, tetanus, pertussis (DTaP) — primary schedule for children under 7; Td/Tdap for children 7+, Polio (IPV), Hepatitis B, Measles, mumps, rubella (MMR) — measles after 12 months, Haemophilus influenzae type b (Hib), Pneumococcal conjugate (PCV), Hepatitis A, Varicella (chickenpox), Required for each child over 2 months enrolled in a child care facility per Minn. Stat. 121A.15; medical exemption (signed physician statement, subd. 3(c)) or conscientious/non-medical exemption (notarized parental statement, subd. 3(d)) permitted — note subd. 3(d) does not apply to a child in a child care center/family child care program that has adopted a policy under subd. 3b; minimum-dose schedule per the MDH Vaccine Doses Guide.

Mississippi

Required vaccines: Proof of vaccination required for every enrolled child before enrollment via the MSDH Certificate of Immunization Compliance (Form 121), or a valid medical/religious exemption (Form 122) — Rule 1.6.3(10); staff and volunteers must also have Form 121 on file (Rule 1.6.3(10); volunteers Rule 1.5.2(6)), Required vaccines per the MSDH childhood immunization schedule (documented on Form 121): DTaP (diphtheria, tetanus, acellular pertussis), Polio (IPV), MMR (measles, mumps, rubella), Hepatitis B (HepB), Varicella (chickenpox), Mississippi historically allowed only medical exemptions, but pursuant to an April 2023 federal court order now also accepts religious exemptions; medical or religious exemption documented on MSDH Form 122 (religious-exemption request process via MSDH; the Form 122 religious exemption does not apply to staff).

Missouri

Required vaccines: Required for any child enrolled in or attending a child care facility, preschool, or nursery school caring for 10 or more children, per 19 CSR 20-28.040 (Day Care Immunization Rule, DHSS — retained under Title 19) and referenced at 5 CSR 25-500.192(4), DTaP/DT (diphtheria, tetanus, acellular pertussis) — age-appropriate doses, IPV / Polio — age-appropriate doses, Hib (Haemophilus influenzae type b) — incl. 1 dose on or after 12 months, Hepatitis B, PCV (pneumococcal conjugate), MMR (measles, mumps, rubella) — at/after 12 months, Varicella (chickenpox) — at/after 12 months, Doses must follow the Missouri Child Care/Preschool Immunization Requirements schedule (ACIP-aligned, incl. catch-up spacing), Exemptions allowed: Medical exemption (form Imm.P.12, licensed physician) and Parent/Guardian (religious/parental) exemption (form Imm.P.11) filed with the facility; 'in progress' status permitted only with an Immunizations In Progress form (Imm.P.14) on file showing the next-dose due date, Facility/administrator must keep an immunization record for each child and submit an annual immunization status summary report (survey) to DHSS by January 15 each year.

Montana

Required vaccines: Measles (MMR), Mumps (MMR), Rubella (MMR), Poliomyelitis (polio), Diphtheria (DTaP/DTP/DT/Tdap), Pertussis / whooping cough (DTaP/DTP/Tdap), Tetanus (DTaP/DTP/DT/Tdap/Td), Varicella (chickenpox), Hepatitis B, Pneumococcal disease (PCV) — not required for children 5 years and older, Haemophilus influenzae type B (Hib) — not required for children 5 years and older, Exemptions allowed: medical contraindication and religious grounds (Affidavit HES-113); conditional/grace-period enrollment permitted (ARM 37.96.802; ARM 37.96.805; ARM 37.96.806).

Nebraska

Required vaccines: DTaP/DTP/DT/Td/Tdap (diphtheria, tetanus, pertussis) per the Childhood Immunization Schedule - 173 NAC 4-004 (Required Levels of Protection), Polio (IPV) - 173 NAC 4-004, Hepatitis B (Hep B) - 173 NAC 4-004, Haemophilus influenzae type b (Hib) - 173 NAC 4-004, Pneumococcal conjugate (PCV) - 173 NAC 4-004, MMR (measles, mumps, rubella) / MMRV - 173 NAC 4-004, Varicella (chickenpox), unless reliable documented history of disease - 173 NAC 4-004, Minimum number of doses of each vaccine is set by the Childhood Immunization Schedule (Attachment 1) incorporated by reference into 173 NAC 4. Medical exemptions (physician/APRN/PA certification) and parental/religious exemptions (written statement) permitted per 391 NAC 3-006.18 and 173 NAC 4. The licensee/director must obtain a copy of each child's immunization record within 30 days of enrollment (391 NAC 3-006.18), and annual reporting to the Department is required per 391 NAC 3-006.18A and 173 NAC 4..

Nevada

Required vaccines: Diphtheria, Tetanus, Pertussis, Poliomyelitis (Polio), Rubella, Rubeola (Measles), Mumps, Hepatitis A, Hepatitis B, Varicella (Chickenpox), Streptococcus Pneumoniae (Pneumococcal/PCV), Haemophilus Influenzae type B (Hib), Certificate of immunization required prior to admission per NRS 432A.230 (conditional admission permitted); medical and religious exemptions allowed (per DWSS/DPBH immunization page, requirements apply unless excused because of a religious belief or medical condition).

New Hampshire

Required vaccines: Documentation of acceptable immunization required for each child prior to admission to a child care agency, per RSA 141-C:20-a and He-P 301.14 (NH Immunization Requirements rule), Required immunizations conform to the NH DHHS Division of Public Health Services schedule (He-P 301.14), following the ACIP/CDC childhood schedule (e.g., DTaP, IPV/polio, MMR, Hib, hepatitis B, varicella, pneumococcal), Conditional enrollment permitted with documentation of at least one dose of each required vaccine plus the appointment date for the next due dose(s), Medical exemption (licensed physician/health care provider certification) and religious exemption (signed NH Childcare/School Immunization Religious Exemption form) permitted under RSA 141-C:20-c, Health assessment / physical examination record required per He-C 4002.10 (Child Record Requirements).

New Jersey

Required vaccines: DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal, Influenza.

New Mexico

Required vaccines: DTaP/DT/Td (Diphtheria, Tetanus, Pertussis) — required series (4 doses sufficient if 4th dose given on/after 4th birthday with 6-month gap; 5 doses optimal), IPV (Polio) — required series; only IPV is valid for the polio requirement, MMR (Measles, Mumps, Rubella) — required; doses given <12 months are invalid and must be repeated; required 2nd dose should be given on/after 4th birthday, Hib (Haemophilus influenzae type b) — required for CYFD/ECECD-regulated child care and pre-school populations (7.5.2.9.H NMAC), Hepatitis B (HepB) — 3-dose series (2 doses of adult Recombivax HB acceptable per schedule), Pneumococcal conjugate (PCV13/PCV15/PCV20) — required; no doses required at 60+ months, Varicella (chickenpox, VAR) — required; doses given <12 months invalid; 2 doses with min 3-month interval for ages 1-12, Hepatitis A (HepA) — required for CYFD/ECECD-regulated child care/pre-school (7.5.2.9.K NMAC); 1st dose required at 15 months, 2nd dose required at 48 months (>6-month interval), Influenza (recommended every year, 6 months and older) and COVID-19 (recommended 6 months-18 years) are NOT required for child care entry, Only medical or religious exemptions are permitted (NMSA 1978 § 24-5-3; 7.5.3.8 NMAC — 'Requirements for Approval of Exemptions from Immunization'); no philosophical/personal exemption. Documented on a Public Health Division-approved Certificate of Exemption; up to 30-day grace period for foster, homeless, or at-risk children per 8.16.2.22(E)(1)(e) NMAC.

New York

Required vaccines: DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Pneumococcal, Meningococcal (required per NY Public Health Law).

North Carolina

Required vaccines: DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A.

North Dakota

Required vaccines: Diphtheria, Pertussis (whooping cough), Tetanus, Measles, Rubella (German measles), Mumps, Hepatitis B, Haemophilus influenzae type b (Hib), Varicella (chickenpox), Poliomyelitis (polio), Pneumococcal disease, Meningococcal disease, Rotavirus, Hepatitis A, Age-appropriate immunization required before admission per N.D.C.C. 23-07-17.1 and N.D. Admin. Code ch. 33-06-05 (early childhood/school immunization requirements; proof of immunization or certificate due within 30 calendar days of enrollment for early childhood facilities); medical exemption by licensed physician, or religious/philosophical/moral exemption by parent/guardian certificate, permitted with documentation; verification of immunization or exemption kept on file per N.D. Admin. Code 75-03-10-22(2)(f).

Ohio

Required vaccines: DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal.

Oklahoma

Required vaccines: Hepatitis B (Hep B), Diphtheria, Tetanus & Pertussis (DTaP), Haemophilus influenzae type b (Hib), Polio (IPV), Measles, Mumps & Rubella (MMR), Varicella/Chickenpox (not required if a parent or treating physician statement confirms the child had chickenpox), Pneumococcal conjugate (PCV), Hepatitis A (Hep A), Required per OAC 340 Appendix II (Immunizations) and 10 O.S. § 411; child care immunization mandate is in 10 O.S. § 411 (not § 281.4). Records or a valid OSDH Form ODH 216A exemption (medical/religious/personal) must be maintained; a one-time 30-calendar-day grace period is allowed. Schedule administered per Oklahoma State Department of Health (OSDH)..

Oregon

Required vaccines: Certified centers must comply with Oregon Health Authority immunization rules per OAR 414-305-0225, which cross-references OAR 333-050-0040 relating to immunization of children (records). OAR 333-050-0050 'Immunization Requirements' is the OHA rule that sets the actual required immunizations., DTaP (Diphtheria, Tetanus, Pertussis), Polio (IPV), MMR (Measles, Mumps, Rubella), Hepatitis B, Hepatitis A, Varicella (Chickenpox), Hib (Haemophilus influenzae type b), Tdap (adolescent booster, per OAR 333-050-0050), Immunization record or valid medical/nonmedical (religious) exemption required; if a child is enrolled in a public or private elementary school, immunizations are not required to be documented by the child care facility (OAR 414-305-0225(1)). Children in foster care or experiencing homelessness may be cared for while parents/guardians take action to comply (OAR 414-305-0225(2))..

Pennsylvania

Required vaccines: DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A.

Rhode Island

Required vaccines: Programs must adopt immunization policies and procedures consistent with the RI Department of Health regulation 216-RICR-30-05-3 (Immunization and Communicable Disease Testing in Preschool, School, Colleges or Universities), per 218-RICR-70-00-1.9(A), Each child must have an immunization record on file (218-RICR-70-00-1.13(F)(7)(d)), Exemption: programs are not required to maintain immunization documentation for children attending public, private, or parochial schools approved by the RI Department of Education (RIDE) (218-RICR-70-00-1.9(A)), 90-day grace period for foster children or children experiencing homelessness to obtain immunization documentation (218-RICR-70-00-1.9(A)), Annual health examination signed by the child's primary care provider also required (218-RICR-70-00-1.9(A)(2)), Staff must complete a Staff Immunization Form (DHS required form).

South Carolina

Required vaccines: Current South Carolina Certificate of Immunization (DHEC Form 2740) required in each child's health record — S.C. Code Regs. 114-503.G.(6)(b), Hepatitis B, Diphtheria, Tetanus, Pertussis (DTaP), Polio (IPV), Measles, Mumps, Rubella (MMR), Varicella (chickenpox), Hib (Haemophilus influenzae type b) — one dose at/after 15 months for children 15–59 months not yet age-appropriately complete; not required at age 5+, Pneumococcal Conjugate (PCV) — one dose on/after the 2nd birthday for children 24–59 months not yet age-appropriately complete, Medical and religious exemptions documented on DHEC 2740 per SC DPH/DHEC.

South Dakota

Required vaccines: REQUIRED (per SDCL 13-28-7.1 / SD Dept. of Health, applies to early childhood programs): Diphtheria, Tetanus, Pertussis (DTaP) — 4+ doses, REQUIRED: Poliovirus (IPV) — 4+ doses, REQUIRED: Measles, Mumps, Rubella (MMR) — 2 doses, REQUIRED: Varicella (chickenpox) — 2 doses, REQUIRED (older entry, age 11/6th grade): Tdap booster and Meningococcal (MCV4), RECOMMENDED, not required: Haemophilus influenzae type b (Hib), RECOMMENDED, not required: Hepatitis B, RECOMMENDED, not required: Hepatitis A, RECOMMENDED, not required: Pneumococcal (PCV), RECOMMENDED, not required: Influenza (annual), HPV, Exemptions: medical contraindication and religious/conscientious objection (Immunization Affidavit, form OLA-106) per ARSD 67:42:17:22.

Tennessee

Required vaccines: Hepatitis B (HBV), Diphtheria-Tetanus-Pertussis (DTaP; DT if appropriate), Poliomyelitis (IPV or OPV), Haemophilus influenzae type B (Hib) - required for age under 5 only, Pneumococcal conjugate vaccine (PCV) - required for age under 5 only, Measles, Mumps, Rubella (MMR) - 1 dose each, Varicella - 1 dose or credible history of disease, Hepatitis A - 1 dose, required by 18 months of age or older, Documented on the Tennessee Department of Health Official Certificate of Immunization (TennIIS); positive serology with year documented accepted as alternative for measles/mumps/rubella/hepatitis A/hepatitis B/varicella; medical and religious exemptions permitted, Per Tenn. Comp. R. & Regs. 1240-04-01-.08(2)(e), the agency must have the Official Immunization Certificate before accepting any child age 2 months or older.

Texas

Required vaccines: DTaP, Polio (IPV), Hib, Hepatitis B, MMR, Varicella, Hepatitis A, Pneumococcal, Influenza (annual, 6-59 months).

Utah

Required vaccines: DTaP (Diphtheria, Tetanus, Pertussis), Polio (IPV), MMR (Measles, Mumps, Rubella), Hepatitis B, Hepatitis A, Varicella (chickenpox), Haemophilus influenzae type b (Hib), Pneumococcal (PCV), Required per Utah Admin. Code R396-100 (Immunization Rule for Students), specifically R396-100-3 (Required Immunizations); early-childhood/childcare entry requires age-appropriate immunization per ACIP for the listed antigens. Medical, religious, or personal exemptions allowed under Utah Code 53G-9-303 (completed exemption form + education module/health-department consult). (COVID-19, influenza, and rotavirus are recommended but not required.).

Vermont

Required vaccines: Each child's file must document the child's current immunization status (Rule 5.1.3), Immunization records must list each immunization administered and its date, updated after each additional dose (Rule 5.1.3), Children in the process of complying per the Vermont recommended immunization schedule must have the required Vermont Department of Health form on file (Rule 5.1.3), Children with a Vermont-allowed exemption must have the required Vermont Department of Health form on file (Rule 5.1.3), Licensee must submit a Vermont Child Care Immunization Report to the VT Dept. of Health, Immunization Office at least once every 365 days, per 18 V.S.A. §§ 1120-1129 (Rule 5.1.4).

Virginia

Required vaccines: DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal.

Washington

Required vaccines: DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A.

West Virginia

Required vaccines: Diphtheria (DTaP), Tetanus (DTaP), Pertussis / whooping cough (DTaP), Polio (IPV), Measles (MMR), Mumps (MMR), Rubella (MMR), Hepatitis B, Varicella / chickenpox, Haemophilus influenzae type b (Hib) — required for child care entry per WV OEPS Child Care Immunization Guidelines, Pneumococcal conjugate (PCV) — required for child care entry per WV OEPS Child Care Immunization Guidelines, Meningitis (meningococcal) — listed in the compulsory-immunization statute W. Va. Code §16-3-4; primarily a school-grade-entry requirement, applicability to child-care entry varies by the OEPS schedule, Authority: W. Va. Code §16-3-4 (compulsory immunization for school and state-regulated child care; MEDICAL exemptions only — no religious or philosophical exemption); under the current rule §78-1-15.1.a an immunization record or completion plan signed by a licensed health care provider must be on file upon admittance, and §78-1-15.1.b recognizes only a medical (licensed-health-care-provider) exemption.

Wisconsin

Required vaccines: DTaP/DTP/DT (diphtheria, tetanus, pertussis), Polio (IPV/OPV), MMR (measles, mumps, rubella), Hepatitis B (Hep B), Varicella (chickenpox) - reliable history of disease accepted per DHS 144.03(2)(g), Hib (Haemophilus influenzae type b), PCV (pneumococcal conjugate), Required under the Wisconsin Student Immunization Law and ch. DHS 144 (DHS 144.03 minimum immunization requirements; child care centers must assess/report status of children age 2-4); written evidence due within 30 school days of admission; health/medical waiver under DHS 144.04 and religious or personal-conviction waiver under DHS 144.05.

Wyoming

Required vaccines: Diphtheria, Tetanus & Pertussis (DTaP), Hepatitis B (HepB), Haemophilus influenzae type b (Hib), Measles, Mumps, and Rubella (MMR), Pneumococcal conjugate (PCV), Polio (IPV), Rotavirus, Varicella (chickenpox), Required and administered per the ACIP Recommended Immunization Schedule, which the Wyoming Department of Health adopts as its mandatory child-care immunization schedule; the specific vaccine roster is set by the WDH/ACIP schedule rather than enumerated in the administrative rule (Ch. 11 Section 16(f) defers to the 'Wyoming Department of Health's mandatory immunization schedule'), Statutory basis: W.S. § 14-4-116 requires children attending child caring facilities to be completely immunized in a manner similar to the school requirement W.S. § 21-4-309; overseen by the Wyoming Department of Health Immunization Unit, Exemptions: only MEDICAL and RELIGIOUS waivers (approved by the State Health Officer or a County Health Officer) are allowed; philosophical/personal-belief exemptions are NOT allowed per Wyoming statute and WDH, Grace period: an additional 60-day grace period may be approved by DFS for a child experiencing homelessness, in foster care, or due to a recent change in family circumstances (Ch. 11 Section 16(f)(i)(A)).

Daycare Immunization Requirements by State (Quick Reference)

A scannable summary of all 50 states. Tap a state name for its full licensing requirements. These figures reflect state childcare licensing rules, not medical advice — verify current schedules with your state health department.

Required childhood immunizations for daycare enrollment in all 50 U.S. states, compiled from state childcare licensing rules.
State	Required Immunizations
Alabama	On the child's first day of attendance, each child from 2 months of age to lawful school age (and each child of lawful school age not enrolled in public/private school kindergarten) must have a valid State of Alabama Certificate of Immunization on file in the center (660-5-26-.08(4)(b)3), Each child's Certificate of Immunization must be kept current and updated according to the expiration date indicated on the certificate, Acceptable in lieu of immunization: a valid State of Alabama Certificate of Medical Exemption, Acceptable in lieu of immunization: a valid Alabama Certificate of Religious Exemption, Children meeting the definition of homelessness under the McKinney-Vento Homeless Assistance Act are excepted (current codified version of 660-5-26-.08(4)(b)3), The underlying immunization schedule and certificate are issued by the Alabama Department of Public Health (ADPH); the day care licensing rule requires the ADPH-issued State of Alabama Certificate of Immunization but does not name a specific form number (e.g., IMM 50)
Alaska	Before admission, the facility must obtain from the parent a valid immunization certificate or evidence the child is exempt (7 AAC 57.550(a)), Acceptable documentation: the child's original immunization record or a physician/provider-documented record showing the dates each required immunization was administered (7 AAC 57.550(b)), Required immunizations follow the Alaska childhood immunization schedule (e.g., DTaP/Tdap, polio/IPV, MMR, Hib, hepatitis B, varicella, pneumococcal/PCV) per the Alaska Division of Public Health childhood schedule, Exemptions permitted: medical exemption, religious exemption, and provisional/temporary exemption for homeless or foster children lacking records (7 AAC 57.550(c)); provisional 30-day enrollment for children lacking available records (7 AAC 57.550(k)); up to 60-day provisional admission in medically underserved communities (7 AAC 57.550(e))
Arizona	DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A
Arkansas	Children must have an authorized record of up-to-date immunizations per the current Arkansas Department of Health (ADH) immunization schedule (MLR Section 604, item h); documentation of a religious or medical exemption is accepted in lieu of records., DTaP/DTP/DT (diphtheria, tetanus, pertussis) — per ADH schedule by age, Polio (IPV), Hib (Haemophilus influenzae type b), Hepatitis B, MMR (measles, mumps, rubella), Varicella (chickenpox), Pneumococcal (PCV), Note: the specific antigen list and schedule are set by ADH (Arkansas Department of Health) rules, not by the MLR; the MLR only requires an 'authorized record of up-to-date immunizations.' Treat the antigen list as the ADH schedule, not as an MLR enumeration.
California	DTaP (Diphtheria, Tetanus, Pertussis), Polio, Hib (Haemophilus influenzae type b), Hepatitis B, MMR (Measles, Mumps, Rubella), Varicella, Hepatitis A (required since 2018)
Colorado	Up-to-date school-required immunizations documented on the CDPHE Certificate of Immunization (or an approved exemption certificate) per Colorado Board of Health rules at 6 CCR 1009-2, on or before the first day of admission (8 CCR 1402-1, Rule 2.219(B)(1)), Standard CDPHE-required vaccines for child care/school entry include DTaP, polio (IPV), MMR (measles/mumps/rubella), hepatitis B, and varicella (chickenpox); plus Hib and pneumococcal (PCV) for younger children, Medical exemption: CDPHE Certificate of Medical Exemption signed by an immunizing provider, Nonmedical (religious/personal-belief) exemption: CDPHE Certificate of Nonmedical Exemption obtained either with an immunizing provider's signature or by completing the CDPHE Online Immunization Education Module (6 CCR 1009-2)
Connecticut	DTaP (diphtheria, tetanus, acellular pertussis), Hib (Haemophilus influenzae type b), Pneumococcal conjugate (PCV), Polio (IPV), MMR (measles, mumps, rubella), Hepatitis B, Hepatitis A (2 doses given six calendar months apart, 1st dose on or after the 1st birthday — required for child care/preschool), Varicella (chickenpox), Influenza (1 dose required each year between Aug 1 and Dec 31 for preschool-age children; NOT required once a child turns 5)
Delaware	Age-appropriate immunizations as required by 14 DE Admin. Code 933 §41.1.4 and detailed in DELACARE Appendix IV (Immunizations), which follows the CDC/ACIP childhood schedule, DTaP/DT (diphtheria, tetanus, pertussis), Polio (IPV), MMR (measles, mumps, rubella), Varicella (chickenpox), Haemophilus influenzae type b (Hib), Hepatitis B, Pneumococcal conjugate (PCV), Health appraisal updated every 13 months (§41.1); proof of blood lead test required for children ages 12 months and older (§41.1.5), Religious or medical exemption permitted with a notarized statement or health-care-provider documentation (§41.3)
Florida	DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal
Georgia	DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal
Hawaii	Governed by HAR Title 11 Chapter 157 (Dept. of Health — Examination and Immunization Requirements); updates effective July 1, 2020; documented on a DOH-approved form (DOE Form 14), For children aged 2 years and older (the GCCH age range): DTaP — 4 doses, Hib (Haemophilus influenzae type b) — 3 to 4 doses (age-dependent), Hepatitis A — 2 doses, Hepatitis B — 3 doses, MMR (measles, mumps, rubella) — 1 dose, PCV (pneumococcal conjugate) — 4 doses, Polio (IPV) — 3 doses, Varicella (chickenpox) — 1 dose (documented history of disease signed by a practitioner may substitute), For children younger than 2 years, the number of required doses depends on the child's age (per HAR 11-157 Immunization Requirements Summary, Table 1), Physical examination within 12 months before first attendance, signed by a licensed practitioner (physician, APRN, or physician assistant), Serologic (lab) evidence of immunity may substitute for an immunization record for certain diseases, Medical and religious exemptions available with appropriate documentation
Idaho	Diphtheria, Tetanus and Acellular Pertussis (DTaP), Polio (IPV), Measles, Mumps, and Rubella (MMR), Haemophilus Influenzae Type B (Hib), Hepatitis B, Varicella (chickenpox), Pneumococcal, Rotavirus, Hepatitis A, Per Idaho Code § 39-1118: immunization record due within 14 days of a child's initial attendance; medical exemption (physician certificate) and religious/other-grounds exemption (signed statement) allowed; non-compliant children excluded by the operator until in compliance, and exempt children may be excluded during a disease outbreak; Department compliance inspections authorized with 30 days' notice (§ 39-1118(5)). Detailed schedule set by IDAPA 16.02.11 (Immunization Requirements for Licensed Daycare Facility Attendees), cross-referenced in IDAPA 16.06.03.380.22
Illinois	DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal
Indiana	Documentation of complete age-appropriate immunizations as required by FSSA/the division with recommendation from the Indiana State Department of Health (ISDH/IDOH), updated annually (470 IAC 3-4.7-86; IC 12-17.2-4-18.1), Conjugated pneumococcal vaccine (PCV) - statutorily required under IC 12-17.2-4-18.1, Varicella (chickenpox) vaccine, or demonstrated immunity to varicella - statutorily required under IC 12-17.2-4-18.1 (also 470 IAC 3-4.7-86), Other age-appropriate immunizations per the ISDH schedule (e.g., DTaP, IPV polio, MMR, Hib, Hepatitis B; specific antigens beyond PCV and varicella are set by ISDH schedule rather than named in statute), Medical exemption: child's physician indicates and updates the exception annually on the child's health record (470 IAC 3-4.7-86; IC 12-17.2-4-18.1), Religious exemption: parent submits a signed written request based on religious beliefs, kept in the child's health record (470 IAC 3-4.7-86; IC 12-17.2-4-18.1), Exemptions do not prevent the center from using emergency first aid or excluding a child when communicable disease control is necessary (470 IAC 3-4.7-86), Written verification of a physical examination by a physician/qualified provider within 30 days after enrollment, or no earlier than 12 months prior to enrollment (470 IAC 3-4.7-86)
Iowa	Diphtheria, tetanus, pertussis (DTaP), Poliomyelitis (IPV), Measles, mumps, rubella (MMR), Varicella (chickenpox), Haemophilus influenzae type b (Hib), Pneumococcal conjugate (PCV), Hepatitis B, Required for children enrolled or attempting to enroll in a licensed child care center per Iowa Admin. Code ch. 641-7 and Iowa Code 139A.8; medical and religious exemptions allowed with a valid department Certificate of Immunization Exemption per 641-7.3. Specific dose counts and age cutoffs (e.g., Hib/PCV age limits; Hepatitis B for children born on/after July 1, 1994) follow the Iowa HHS immunization requirements chart and were not individually re-verified in this pass.
Kansas	Diphtheria, tetanus, and pertussis (DTaP), Poliomyelitis (polio), Measles, mumps, and rubella (MMR), Hepatitis B, Hepatitis A, Varicella (chickenpox), Haemophilus influenzae type B (Hib), Pneumococcal disease (PCV), Required current and age-appropriate for child care/preschool per K.A.R. 28-1-20(d); immunization records maintained on each child's medical record per K.A.R. 28-4-430(a)(5); exceptions permitted for medical reasons (certification from a licensed physician) or religious reasons per K.S.A. 65-508(h) (cross-referenced for child care by K.A.R. 28-4-430(a)(6))
Kentucky	Current Commonwealth of Kentucky Certificate of Immunization Status required to attend a child-care center, certified family child-care home, or other licensed facility, beginning at age 3 months (902 KAR 2:060), Hepatitis B (HepB), Diphtheria, Tetanus, acellular Pertussis (DTaP/DTP), Poliovirus (IPV/OPV), Haemophilus influenzae type b (Hib), Pneumococcal conjugate (PCV), Measles, Mumps, Rubella (MMR), Varicella (chickenpox), Hepatitis A (HepA), Medical exemption via Certificate marked to designate a medical contraindication; religious exemption via the notarized Declination on Religious Grounds form (902 KAR 2:060)
Louisiana	Required under La. R.S. 17:170: proof of immunization (or program in progress) presented at entry; chief administrators of licensed daycare centers must check records and enforce compliance, Diphtheria, Tetanus, Pertussis (DTaP), Poliomyelitis (IPV/polio), Measles, Mumps, Rubella (MMR), Hepatitis B, Varicella (chickenpox), Haemophilus influenzae Type B (Hib) - for children under 4 in Pre-K/Daycare/Head Start, Pneumococcal Conjugate (PCV) and Rotavirus - for children under 4 in Pre-K/Daycare/Head Start, Immunization schedule set by the LA Department of Health (LDH) Office of Public Health (LAC Title 51, Part II, §701), Centers must make parents aware of influenza immunization information by November 1 of each year (§1915)
Maine	Measles, Mumps, Rubella, Diphtheria, Pertussis, Polio, Tetanus, Haemophilus influenzae Type b (Hib), Varicella (chickenpox), Hepatitis B, Pneumococcal conjugate (PCV)
Maryland	DTaP/DTP (diphtheria, tetanus, pertussis), Polio (IPV), MMR (measles, mumps, rubella) — doses on or after first birthday, Hib (Haemophilus influenzae type b) — required through 59 months of age, PCV (pneumococcal conjugate / Prevnar) — required through 59 months of age, Hepatitis B, Varicella (chickenpox) — doses on or after first birthday, Documentation required on Maryland Department of Health Immunization Certificate (MDH Form 896). COMAR 13A.16.03.04 (Child Records) requires the operator to obtain and maintain an immunization record showing the child has age-appropriate immunizations meeting Maryland Department of Health guidelines; temporary/provisional admission pending immunization is addressed in COMAR 13A.16.03.02 F. Medical and religious exemptions are recognized., Blood lead screening / test verification required for children under 6 years old (COMAR 13A.16.03.02 E)
Massachusetts	DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal, Meningococcal, Influenza
Michigan	DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal
Minnesota	Diphtheria, tetanus, pertussis (DTaP) — primary schedule for children under 7; Td/Tdap for children 7+, Polio (IPV), Hepatitis B, Measles, mumps, rubella (MMR) — measles after 12 months, Haemophilus influenzae type b (Hib), Pneumococcal conjugate (PCV), Hepatitis A, Varicella (chickenpox), Required for each child over 2 months enrolled in a child care facility per Minn. Stat. 121A.15; medical exemption (signed physician statement, subd. 3(c)) or conscientious/non-medical exemption (notarized parental statement, subd. 3(d)) permitted — note subd. 3(d) does not apply to a child in a child care center/family child care program that has adopted a policy under subd. 3b; minimum-dose schedule per the MDH Vaccine Doses Guide
Mississippi	Proof of vaccination required for every enrolled child before enrollment via the MSDH Certificate of Immunization Compliance (Form 121), or a valid medical/religious exemption (Form 122) — Rule 1.6.3(10); staff and volunteers must also have Form 121 on file (Rule 1.6.3(10); volunteers Rule 1.5.2(6)), Required vaccines per the MSDH childhood immunization schedule (documented on Form 121): DTaP (diphtheria, tetanus, acellular pertussis), Polio (IPV), MMR (measles, mumps, rubella), Hepatitis B (HepB), Varicella (chickenpox), Mississippi historically allowed only medical exemptions, but pursuant to an April 2023 federal court order now also accepts religious exemptions; medical or religious exemption documented on MSDH Form 122 (religious-exemption request process via MSDH; the Form 122 religious exemption does not apply to staff)
Missouri	Required for any child enrolled in or attending a child care facility, preschool, or nursery school caring for 10 or more children, per 19 CSR 20-28.040 (Day Care Immunization Rule, DHSS — retained under Title 19) and referenced at 5 CSR 25-500.192(4), DTaP/DT (diphtheria, tetanus, acellular pertussis) — age-appropriate doses, IPV / Polio — age-appropriate doses, Hib (Haemophilus influenzae type b) — incl. 1 dose on or after 12 months, Hepatitis B, PCV (pneumococcal conjugate), MMR (measles, mumps, rubella) — at/after 12 months, Varicella (chickenpox) — at/after 12 months, Doses must follow the Missouri Child Care/Preschool Immunization Requirements schedule (ACIP-aligned, incl. catch-up spacing), Exemptions allowed: Medical exemption (form Imm.P.12, licensed physician) and Parent/Guardian (religious/parental) exemption (form Imm.P.11) filed with the facility; 'in progress' status permitted only with an Immunizations In Progress form (Imm.P.14) on file showing the next-dose due date, Facility/administrator must keep an immunization record for each child and submit an annual immunization status summary report (survey) to DHSS by January 15 each year
Montana	Measles (MMR), Mumps (MMR), Rubella (MMR), Poliomyelitis (polio), Diphtheria (DTaP/DTP/DT/Tdap), Pertussis / whooping cough (DTaP/DTP/Tdap), Tetanus (DTaP/DTP/DT/Tdap/Td), Varicella (chickenpox), Hepatitis B, Pneumococcal disease (PCV) — not required for children 5 years and older, Haemophilus influenzae type B (Hib) — not required for children 5 years and older, Exemptions allowed: medical contraindication and religious grounds (Affidavit HES-113); conditional/grace-period enrollment permitted (ARM 37.96.802; ARM 37.96.805; ARM 37.96.806)
Nebraska	DTaP/DTP/DT/Td/Tdap (diphtheria, tetanus, pertussis) per the Childhood Immunization Schedule - 173 NAC 4-004 (Required Levels of Protection), Polio (IPV) - 173 NAC 4-004, Hepatitis B (Hep B) - 173 NAC 4-004, Haemophilus influenzae type b (Hib) - 173 NAC 4-004, Pneumococcal conjugate (PCV) - 173 NAC 4-004, MMR (measles, mumps, rubella) / MMRV - 173 NAC 4-004, Varicella (chickenpox), unless reliable documented history of disease - 173 NAC 4-004, Minimum number of doses of each vaccine is set by the Childhood Immunization Schedule (Attachment 1) incorporated by reference into 173 NAC 4. Medical exemptions (physician/APRN/PA certification) and parental/religious exemptions (written statement) permitted per 391 NAC 3-006.18 and 173 NAC 4. The licensee/director must obtain a copy of each child's immunization record within 30 days of enrollment (391 NAC 3-006.18), and annual reporting to the Department is required per 391 NAC 3-006.18A and 173 NAC 4.
Nevada	Diphtheria, Tetanus, Pertussis, Poliomyelitis (Polio), Rubella, Rubeola (Measles), Mumps, Hepatitis A, Hepatitis B, Varicella (Chickenpox), Streptococcus Pneumoniae (Pneumococcal/PCV), Haemophilus Influenzae type B (Hib), Certificate of immunization required prior to admission per NRS 432A.230 (conditional admission permitted); medical and religious exemptions allowed (per DWSS/DPBH immunization page, requirements apply unless excused because of a religious belief or medical condition)
New Hampshire	Documentation of acceptable immunization required for each child prior to admission to a child care agency, per RSA 141-C:20-a and He-P 301.14 (NH Immunization Requirements rule), Required immunizations conform to the NH DHHS Division of Public Health Services schedule (He-P 301.14), following the ACIP/CDC childhood schedule (e.g., DTaP, IPV/polio, MMR, Hib, hepatitis B, varicella, pneumococcal), Conditional enrollment permitted with documentation of at least one dose of each required vaccine plus the appointment date for the next due dose(s), Medical exemption (licensed physician/health care provider certification) and religious exemption (signed NH Childcare/School Immunization Religious Exemption form) permitted under RSA 141-C:20-c, Health assessment / physical examination record required per He-C 4002.10 (Child Record Requirements)
New Jersey	DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal, Influenza
New Mexico	DTaP/DT/Td (Diphtheria, Tetanus, Pertussis) — required series (4 doses sufficient if 4th dose given on/after 4th birthday with 6-month gap; 5 doses optimal), IPV (Polio) — required series; only IPV is valid for the polio requirement, MMR (Measles, Mumps, Rubella) — required; doses given <12 months are invalid and must be repeated; required 2nd dose should be given on/after 4th birthday, Hib (Haemophilus influenzae type b) — required for CYFD/ECECD-regulated child care and pre-school populations (7.5.2.9.H NMAC), Hepatitis B (HepB) — 3-dose series (2 doses of adult Recombivax HB acceptable per schedule), Pneumococcal conjugate (PCV13/PCV15/PCV20) — required; no doses required at 60+ months, Varicella (chickenpox, VAR) — required; doses given <12 months invalid; 2 doses with min 3-month interval for ages 1-12, Hepatitis A (HepA) — required for CYFD/ECECD-regulated child care/pre-school (7.5.2.9.K NMAC); 1st dose required at 15 months, 2nd dose required at 48 months (>6-month interval), Influenza (recommended every year, 6 months and older) and COVID-19 (recommended 6 months-18 years) are NOT required for child care entry, Only medical or religious exemptions are permitted (NMSA 1978 § 24-5-3; 7.5.3.8 NMAC — 'Requirements for Approval of Exemptions from Immunization'); no philosophical/personal exemption. Documented on a Public Health Division-approved Certificate of Exemption; up to 30-day grace period for foster, homeless, or at-risk children per 8.16.2.22(E)(1)(e) NMAC
New York	DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Pneumococcal, Meningococcal (required per NY Public Health Law)
North Carolina	DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A
North Dakota	Diphtheria, Pertussis (whooping cough), Tetanus, Measles, Rubella (German measles), Mumps, Hepatitis B, Haemophilus influenzae type b (Hib), Varicella (chickenpox), Poliomyelitis (polio), Pneumococcal disease, Meningococcal disease, Rotavirus, Hepatitis A, Age-appropriate immunization required before admission per N.D.C.C. 23-07-17.1 and N.D. Admin. Code ch. 33-06-05 (early childhood/school immunization requirements; proof of immunization or certificate due within 30 calendar days of enrollment for early childhood facilities); medical exemption by licensed physician, or religious/philosophical/moral exemption by parent/guardian certificate, permitted with documentation; verification of immunization or exemption kept on file per N.D. Admin. Code 75-03-10-22(2)(f)
Ohio	DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal
Oklahoma	Hepatitis B (Hep B), Diphtheria, Tetanus & Pertussis (DTaP), Haemophilus influenzae type b (Hib), Polio (IPV), Measles, Mumps & Rubella (MMR), Varicella/Chickenpox (not required if a parent or treating physician statement confirms the child had chickenpox), Pneumococcal conjugate (PCV), Hepatitis A (Hep A), Required per OAC 340 Appendix II (Immunizations) and 10 O.S. § 411; child care immunization mandate is in 10 O.S. § 411 (not § 281.4). Records or a valid OSDH Form ODH 216A exemption (medical/religious/personal) must be maintained; a one-time 30-calendar-day grace period is allowed. Schedule administered per Oklahoma State Department of Health (OSDH).
Oregon	Certified centers must comply with Oregon Health Authority immunization rules per OAR 414-305-0225, which cross-references OAR 333-050-0040 relating to immunization of children (records). OAR 333-050-0050 'Immunization Requirements' is the OHA rule that sets the actual required immunizations., DTaP (Diphtheria, Tetanus, Pertussis), Polio (IPV), MMR (Measles, Mumps, Rubella), Hepatitis B, Hepatitis A, Varicella (Chickenpox), Hib (Haemophilus influenzae type b), Tdap (adolescent booster, per OAR 333-050-0050), Immunization record or valid medical/nonmedical (religious) exemption required; if a child is enrolled in a public or private elementary school, immunizations are not required to be documented by the child care facility (OAR 414-305-0225(1)). Children in foster care or experiencing homelessness may be cared for while parents/guardians take action to comply (OAR 414-305-0225(2)).
Pennsylvania	DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A
Rhode Island	Programs must adopt immunization policies and procedures consistent with the RI Department of Health regulation 216-RICR-30-05-3 (Immunization and Communicable Disease Testing in Preschool, School, Colleges or Universities), per 218-RICR-70-00-1.9(A), Each child must have an immunization record on file (218-RICR-70-00-1.13(F)(7)(d)), Exemption: programs are not required to maintain immunization documentation for children attending public, private, or parochial schools approved by the RI Department of Education (RIDE) (218-RICR-70-00-1.9(A)), 90-day grace period for foster children or children experiencing homelessness to obtain immunization documentation (218-RICR-70-00-1.9(A)), Annual health examination signed by the child's primary care provider also required (218-RICR-70-00-1.9(A)(2)), Staff must complete a Staff Immunization Form (DHS required form)
South Carolina	Current South Carolina Certificate of Immunization (DHEC Form 2740) required in each child's health record — S.C. Code Regs. 114-503.G.(6)(b), Hepatitis B, Diphtheria, Tetanus, Pertussis (DTaP), Polio (IPV), Measles, Mumps, Rubella (MMR), Varicella (chickenpox), Hib (Haemophilus influenzae type b) — one dose at/after 15 months for children 15–59 months not yet age-appropriately complete; not required at age 5+, Pneumococcal Conjugate (PCV) — one dose on/after the 2nd birthday for children 24–59 months not yet age-appropriately complete, Medical and religious exemptions documented on DHEC 2740 per SC DPH/DHEC
South Dakota	REQUIRED (per SDCL 13-28-7.1 / SD Dept. of Health, applies to early childhood programs): Diphtheria, Tetanus, Pertussis (DTaP) — 4+ doses, REQUIRED: Poliovirus (IPV) — 4+ doses, REQUIRED: Measles, Mumps, Rubella (MMR) — 2 doses, REQUIRED: Varicella (chickenpox) — 2 doses, REQUIRED (older entry, age 11/6th grade): Tdap booster and Meningococcal (MCV4), RECOMMENDED, not required: Haemophilus influenzae type b (Hib), RECOMMENDED, not required: Hepatitis B, RECOMMENDED, not required: Hepatitis A, RECOMMENDED, not required: Pneumococcal (PCV), RECOMMENDED, not required: Influenza (annual), HPV, Exemptions: medical contraindication and religious/conscientious objection (Immunization Affidavit, form OLA-106) per ARSD 67:42:17:22
Tennessee	Hepatitis B (HBV), Diphtheria-Tetanus-Pertussis (DTaP; DT if appropriate), Poliomyelitis (IPV or OPV), Haemophilus influenzae type B (Hib) - required for age under 5 only, Pneumococcal conjugate vaccine (PCV) - required for age under 5 only, Measles, Mumps, Rubella (MMR) - 1 dose each, Varicella - 1 dose or credible history of disease, Hepatitis A - 1 dose, required by 18 months of age or older, Documented on the Tennessee Department of Health Official Certificate of Immunization (TennIIS); positive serology with year documented accepted as alternative for measles/mumps/rubella/hepatitis A/hepatitis B/varicella; medical and religious exemptions permitted, Per Tenn. Comp. R. & Regs. 1240-04-01-.08(2)(e), the agency must have the Official Immunization Certificate before accepting any child age 2 months or older
Texas	DTaP, Polio (IPV), Hib, Hepatitis B, MMR, Varicella, Hepatitis A, Pneumococcal, Influenza (annual, 6-59 months)
Utah	DTaP (Diphtheria, Tetanus, Pertussis), Polio (IPV), MMR (Measles, Mumps, Rubella), Hepatitis B, Hepatitis A, Varicella (chickenpox), Haemophilus influenzae type b (Hib), Pneumococcal (PCV), Required per Utah Admin. Code R396-100 (Immunization Rule for Students), specifically R396-100-3 (Required Immunizations); early-childhood/childcare entry requires age-appropriate immunization per ACIP for the listed antigens. Medical, religious, or personal exemptions allowed under Utah Code 53G-9-303 (completed exemption form + education module/health-department consult). (COVID-19, influenza, and rotavirus are recommended but not required.)
Vermont	Each child's file must document the child's current immunization status (Rule 5.1.3), Immunization records must list each immunization administered and its date, updated after each additional dose (Rule 5.1.3), Children in the process of complying per the Vermont recommended immunization schedule must have the required Vermont Department of Health form on file (Rule 5.1.3), Children with a Vermont-allowed exemption must have the required Vermont Department of Health form on file (Rule 5.1.3), Licensee must submit a Vermont Child Care Immunization Report to the VT Dept. of Health, Immunization Office at least once every 365 days, per 18 V.S.A. §§ 1120-1129 (Rule 5.1.4)
Virginia	DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal
Washington	DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A
West Virginia	Diphtheria (DTaP), Tetanus (DTaP), Pertussis / whooping cough (DTaP), Polio (IPV), Measles (MMR), Mumps (MMR), Rubella (MMR), Hepatitis B, Varicella / chickenpox, Haemophilus influenzae type b (Hib) — required for child care entry per WV OEPS Child Care Immunization Guidelines, Pneumococcal conjugate (PCV) — required for child care entry per WV OEPS Child Care Immunization Guidelines, Meningitis (meningococcal) — listed in the compulsory-immunization statute W. Va. Code §16-3-4; primarily a school-grade-entry requirement, applicability to child-care entry varies by the OEPS schedule, Authority: W. Va. Code §16-3-4 (compulsory immunization for school and state-regulated child care; MEDICAL exemptions only — no religious or philosophical exemption); under the current rule §78-1-15.1.a an immunization record or completion plan signed by a licensed health care provider must be on file upon admittance, and §78-1-15.1.b recognizes only a medical (licensed-health-care-provider) exemption
Wisconsin	DTaP/DTP/DT (diphtheria, tetanus, pertussis), Polio (IPV/OPV), MMR (measles, mumps, rubella), Hepatitis B (Hep B), Varicella (chickenpox) - reliable history of disease accepted per DHS 144.03(2)(g), Hib (Haemophilus influenzae type b), PCV (pneumococcal conjugate), Required under the Wisconsin Student Immunization Law and ch. DHS 144 (DHS 144.03 minimum immunization requirements; child care centers must assess/report status of children age 2-4); written evidence due within 30 school days of admission; health/medical waiver under DHS 144.04 and religious or personal-conviction waiver under DHS 144.05
Wyoming	Diphtheria, Tetanus & Pertussis (DTaP), Hepatitis B (HepB), Haemophilus influenzae type b (Hib), Measles, Mumps, and Rubella (MMR), Pneumococcal conjugate (PCV), Polio (IPV), Rotavirus, Varicella (chickenpox), Required and administered per the ACIP Recommended Immunization Schedule, which the Wyoming Department of Health adopts as its mandatory child-care immunization schedule; the specific vaccine roster is set by the WDH/ACIP schedule rather than enumerated in the administrative rule (Ch. 11 Section 16(f) defers to the 'Wyoming Department of Health's mandatory immunization schedule'), Statutory basis: W.S. § 14-4-116 requires children attending child caring facilities to be completely immunized in a manner similar to the school requirement W.S. § 21-4-309; overseen by the Wyoming Department of Health Immunization Unit, Exemptions: only MEDICAL and RELIGIOUS waivers (approved by the State Health Officer or a County Health Officer) are allowed; philosophical/personal-belief exemptions are NOT allowed per Wyoming statute and WDH, Grace period: an additional 60-day grace period may be approved by DFS for a child experiencing homelessness, in foster care, or due to a recent change in family circumstances (Ch. 11 Section 16(f)(i)(A))

Alabama

On the child's first day of attendance, each child from 2 months of age to lawful school age (and each child of lawful school age not enrolled in public/private school kindergarten) must have a valid State of Alabama Certificate of Immunization on file in the center (660-5-26-.08(4)(b)3), Each child's Certificate of Immunization must be kept current and updated according to the expiration date indicated on the certificate, Acceptable in lieu of immunization: a valid State of Alabama Certificate of Medical Exemption, Acceptable in lieu of immunization: a valid Alabama Certificate of Religious Exemption, Children meeting the definition of homelessness under the McKinney-Vento Homeless Assistance Act are excepted (current codified version of 660-5-26-.08(4)(b)3), The underlying immunization schedule and certificate are issued by the Alabama Department of Public Health (ADPH); the day care licensing rule requires the ADPH-issued State of Alabama Certificate of Immunization but does not name a specific form number (e.g., IMM 50)

Alaska

Before admission, the facility must obtain from the parent a valid immunization certificate or evidence the child is exempt (7 AAC 57.550(a)), Acceptable documentation: the child's original immunization record or a physician/provider-documented record showing the dates each required immunization was administered (7 AAC 57.550(b)), Required immunizations follow the Alaska childhood immunization schedule (e.g., DTaP/Tdap, polio/IPV, MMR, Hib, hepatitis B, varicella, pneumococcal/PCV) per the Alaska Division of Public Health childhood schedule, Exemptions permitted: medical exemption, religious exemption, and provisional/temporary exemption for homeless or foster children lacking records (7 AAC 57.550(c)); provisional 30-day enrollment for children lacking available records (7 AAC 57.550(k)); up to 60-day provisional admission in medically underserved communities (7 AAC 57.550(e))

Arizona

DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A

Arkansas

Children must have an authorized record of up-to-date immunizations per the current Arkansas Department of Health (ADH) immunization schedule (MLR Section 604, item h); documentation of a religious or medical exemption is accepted in lieu of records., DTaP/DTP/DT (diphtheria, tetanus, pertussis) — per ADH schedule by age, Polio (IPV), Hib (Haemophilus influenzae type b), Hepatitis B, MMR (measles, mumps, rubella), Varicella (chickenpox), Pneumococcal (PCV), Note: the specific antigen list and schedule are set by ADH (Arkansas Department of Health) rules, not by the MLR; the MLR only requires an 'authorized record of up-to-date immunizations.' Treat the antigen list as the ADH schedule, not as an MLR enumeration.

California

DTaP (Diphtheria, Tetanus, Pertussis), Polio, Hib (Haemophilus influenzae type b), Hepatitis B, MMR (Measles, Mumps, Rubella), Varicella, Hepatitis A (required since 2018)

Colorado

Up-to-date school-required immunizations documented on the CDPHE Certificate of Immunization (or an approved exemption certificate) per Colorado Board of Health rules at 6 CCR 1009-2, on or before the first day of admission (8 CCR 1402-1, Rule 2.219(B)(1)), Standard CDPHE-required vaccines for child care/school entry include DTaP, polio (IPV), MMR (measles/mumps/rubella), hepatitis B, and varicella (chickenpox); plus Hib and pneumococcal (PCV) for younger children, Medical exemption: CDPHE Certificate of Medical Exemption signed by an immunizing provider, Nonmedical (religious/personal-belief) exemption: CDPHE Certificate of Nonmedical Exemption obtained either with an immunizing provider's signature or by completing the CDPHE Online Immunization Education Module (6 CCR 1009-2)

Connecticut

DTaP (diphtheria, tetanus, acellular pertussis), Hib (Haemophilus influenzae type b), Pneumococcal conjugate (PCV), Polio (IPV), MMR (measles, mumps, rubella), Hepatitis B, Hepatitis A (2 doses given six calendar months apart, 1st dose on or after the 1st birthday — required for child care/preschool), Varicella (chickenpox), Influenza (1 dose required each year between Aug 1 and Dec 31 for preschool-age children; NOT required once a child turns 5)

Delaware

Age-appropriate immunizations as required by 14 DE Admin. Code 933 §41.1.4 and detailed in DELACARE Appendix IV (Immunizations), which follows the CDC/ACIP childhood schedule, DTaP/DT (diphtheria, tetanus, pertussis), Polio (IPV), MMR (measles, mumps, rubella), Varicella (chickenpox), Haemophilus influenzae type b (Hib), Hepatitis B, Pneumococcal conjugate (PCV), Health appraisal updated every 13 months (§41.1); proof of blood lead test required for children ages 12 months and older (§41.1.5), Religious or medical exemption permitted with a notarized statement or health-care-provider documentation (§41.3)

Florida

DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal

Georgia

DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal

Hawaii

Governed by HAR Title 11 Chapter 157 (Dept. of Health — Examination and Immunization Requirements); updates effective July 1, 2020; documented on a DOH-approved form (DOE Form 14), For children aged 2 years and older (the GCCH age range): DTaP — 4 doses, Hib (Haemophilus influenzae type b) — 3 to 4 doses (age-dependent), Hepatitis A — 2 doses, Hepatitis B — 3 doses, MMR (measles, mumps, rubella) — 1 dose, PCV (pneumococcal conjugate) — 4 doses, Polio (IPV) — 3 doses, Varicella (chickenpox) — 1 dose (documented history of disease signed by a practitioner may substitute), For children younger than 2 years, the number of required doses depends on the child's age (per HAR 11-157 Immunization Requirements Summary, Table 1), Physical examination within 12 months before first attendance, signed by a licensed practitioner (physician, APRN, or physician assistant), Serologic (lab) evidence of immunity may substitute for an immunization record for certain diseases, Medical and religious exemptions available with appropriate documentation

Idaho

Diphtheria, Tetanus and Acellular Pertussis (DTaP), Polio (IPV), Measles, Mumps, and Rubella (MMR), Haemophilus Influenzae Type B (Hib), Hepatitis B, Varicella (chickenpox), Pneumococcal, Rotavirus, Hepatitis A, Per Idaho Code § 39-1118: immunization record due within 14 days of a child's initial attendance; medical exemption (physician certificate) and religious/other-grounds exemption (signed statement) allowed; non-compliant children excluded by the operator until in compliance, and exempt children may be excluded during a disease outbreak; Department compliance inspections authorized with 30 days' notice (§ 39-1118(5)). Detailed schedule set by IDAPA 16.02.11 (Immunization Requirements for Licensed Daycare Facility Attendees), cross-referenced in IDAPA 16.06.03.380.22

Illinois

DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal

Indiana

Documentation of complete age-appropriate immunizations as required by FSSA/the division with recommendation from the Indiana State Department of Health (ISDH/IDOH), updated annually (470 IAC 3-4.7-86; IC 12-17.2-4-18.1), Conjugated pneumococcal vaccine (PCV) - statutorily required under IC 12-17.2-4-18.1, Varicella (chickenpox) vaccine, or demonstrated immunity to varicella - statutorily required under IC 12-17.2-4-18.1 (also 470 IAC 3-4.7-86), Other age-appropriate immunizations per the ISDH schedule (e.g., DTaP, IPV polio, MMR, Hib, Hepatitis B; specific antigens beyond PCV and varicella are set by ISDH schedule rather than named in statute), Medical exemption: child's physician indicates and updates the exception annually on the child's health record (470 IAC 3-4.7-86; IC 12-17.2-4-18.1), Religious exemption: parent submits a signed written request based on religious beliefs, kept in the child's health record (470 IAC 3-4.7-86; IC 12-17.2-4-18.1), Exemptions do not prevent the center from using emergency first aid or excluding a child when communicable disease control is necessary (470 IAC 3-4.7-86), Written verification of a physical examination by a physician/qualified provider within 30 days after enrollment, or no earlier than 12 months prior to enrollment (470 IAC 3-4.7-86)

Iowa

Diphtheria, tetanus, pertussis (DTaP), Poliomyelitis (IPV), Measles, mumps, rubella (MMR), Varicella (chickenpox), Haemophilus influenzae type b (Hib), Pneumococcal conjugate (PCV), Hepatitis B, Required for children enrolled or attempting to enroll in a licensed child care center per Iowa Admin. Code ch. 641-7 and Iowa Code 139A.8; medical and religious exemptions allowed with a valid department Certificate of Immunization Exemption per 641-7.3. Specific dose counts and age cutoffs (e.g., Hib/PCV age limits; Hepatitis B for children born on/after July 1, 1994) follow the Iowa HHS immunization requirements chart and were not individually re-verified in this pass.

Kansas

Diphtheria, tetanus, and pertussis (DTaP), Poliomyelitis (polio), Measles, mumps, and rubella (MMR), Hepatitis B, Hepatitis A, Varicella (chickenpox), Haemophilus influenzae type B (Hib), Pneumococcal disease (PCV), Required current and age-appropriate for child care/preschool per K.A.R. 28-1-20(d); immunization records maintained on each child's medical record per K.A.R. 28-4-430(a)(5); exceptions permitted for medical reasons (certification from a licensed physician) or religious reasons per K.S.A. 65-508(h) (cross-referenced for child care by K.A.R. 28-4-430(a)(6))

Kentucky

Current Commonwealth of Kentucky Certificate of Immunization Status required to attend a child-care center, certified family child-care home, or other licensed facility, beginning at age 3 months (902 KAR 2:060), Hepatitis B (HepB), Diphtheria, Tetanus, acellular Pertussis (DTaP/DTP), Poliovirus (IPV/OPV), Haemophilus influenzae type b (Hib), Pneumococcal conjugate (PCV), Measles, Mumps, Rubella (MMR), Varicella (chickenpox), Hepatitis A (HepA), Medical exemption via Certificate marked to designate a medical contraindication; religious exemption via the notarized Declination on Religious Grounds form (902 KAR 2:060)

Louisiana

Required under La. R.S. 17:170: proof of immunization (or program in progress) presented at entry; chief administrators of licensed daycare centers must check records and enforce compliance, Diphtheria, Tetanus, Pertussis (DTaP), Poliomyelitis (IPV/polio), Measles, Mumps, Rubella (MMR), Hepatitis B, Varicella (chickenpox), Haemophilus influenzae Type B (Hib) - for children under 4 in Pre-K/Daycare/Head Start, Pneumococcal Conjugate (PCV) and Rotavirus - for children under 4 in Pre-K/Daycare/Head Start, Immunization schedule set by the LA Department of Health (LDH) Office of Public Health (LAC Title 51, Part II, §701), Centers must make parents aware of influenza immunization information by November 1 of each year (§1915)

Maine

Measles, Mumps, Rubella, Diphtheria, Pertussis, Polio, Tetanus, Haemophilus influenzae Type b (Hib), Varicella (chickenpox), Hepatitis B, Pneumococcal conjugate (PCV)

Maryland

DTaP/DTP (diphtheria, tetanus, pertussis), Polio (IPV), MMR (measles, mumps, rubella) — doses on or after first birthday, Hib (Haemophilus influenzae type b) — required through 59 months of age, PCV (pneumococcal conjugate / Prevnar) — required through 59 months of age, Hepatitis B, Varicella (chickenpox) — doses on or after first birthday, Documentation required on Maryland Department of Health Immunization Certificate (MDH Form 896). COMAR 13A.16.03.04 (Child Records) requires the operator to obtain and maintain an immunization record showing the child has age-appropriate immunizations meeting Maryland Department of Health guidelines; temporary/provisional admission pending immunization is addressed in COMAR 13A.16.03.02 F. Medical and religious exemptions are recognized., Blood lead screening / test verification required for children under 6 years old (COMAR 13A.16.03.02 E)

Massachusetts

DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal, Meningococcal, Influenza

Michigan

DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal

Minnesota

Diphtheria, tetanus, pertussis (DTaP) — primary schedule for children under 7; Td/Tdap for children 7+, Polio (IPV), Hepatitis B, Measles, mumps, rubella (MMR) — measles after 12 months, Haemophilus influenzae type b (Hib), Pneumococcal conjugate (PCV), Hepatitis A, Varicella (chickenpox), Required for each child over 2 months enrolled in a child care facility per Minn. Stat. 121A.15; medical exemption (signed physician statement, subd. 3(c)) or conscientious/non-medical exemption (notarized parental statement, subd. 3(d)) permitted — note subd. 3(d) does not apply to a child in a child care center/family child care program that has adopted a policy under subd. 3b; minimum-dose schedule per the MDH Vaccine Doses Guide

Mississippi

Proof of vaccination required for every enrolled child before enrollment via the MSDH Certificate of Immunization Compliance (Form 121), or a valid medical/religious exemption (Form 122) — Rule 1.6.3(10); staff and volunteers must also have Form 121 on file (Rule 1.6.3(10); volunteers Rule 1.5.2(6)), Required vaccines per the MSDH childhood immunization schedule (documented on Form 121): DTaP (diphtheria, tetanus, acellular pertussis), Polio (IPV), MMR (measles, mumps, rubella), Hepatitis B (HepB), Varicella (chickenpox), Mississippi historically allowed only medical exemptions, but pursuant to an April 2023 federal court order now also accepts religious exemptions; medical or religious exemption documented on MSDH Form 122 (religious-exemption request process via MSDH; the Form 122 religious exemption does not apply to staff)

Missouri

Required for any child enrolled in or attending a child care facility, preschool, or nursery school caring for 10 or more children, per 19 CSR 20-28.040 (Day Care Immunization Rule, DHSS — retained under Title 19) and referenced at 5 CSR 25-500.192(4), DTaP/DT (diphtheria, tetanus, acellular pertussis) — age-appropriate doses, IPV / Polio — age-appropriate doses, Hib (Haemophilus influenzae type b) — incl. 1 dose on or after 12 months, Hepatitis B, PCV (pneumococcal conjugate), MMR (measles, mumps, rubella) — at/after 12 months, Varicella (chickenpox) — at/after 12 months, Doses must follow the Missouri Child Care/Preschool Immunization Requirements schedule (ACIP-aligned, incl. catch-up spacing), Exemptions allowed: Medical exemption (form Imm.P.12, licensed physician) and Parent/Guardian (religious/parental) exemption (form Imm.P.11) filed with the facility; 'in progress' status permitted only with an Immunizations In Progress form (Imm.P.14) on file showing the next-dose due date, Facility/administrator must keep an immunization record for each child and submit an annual immunization status summary report (survey) to DHSS by January 15 each year

Montana

Measles (MMR), Mumps (MMR), Rubella (MMR), Poliomyelitis (polio), Diphtheria (DTaP/DTP/DT/Tdap), Pertussis / whooping cough (DTaP/DTP/Tdap), Tetanus (DTaP/DTP/DT/Tdap/Td), Varicella (chickenpox), Hepatitis B, Pneumococcal disease (PCV) — not required for children 5 years and older, Haemophilus influenzae type B (Hib) — not required for children 5 years and older, Exemptions allowed: medical contraindication and religious grounds (Affidavit HES-113); conditional/grace-period enrollment permitted (ARM 37.96.802; ARM 37.96.805; ARM 37.96.806)

Nebraska

DTaP/DTP/DT/Td/Tdap (diphtheria, tetanus, pertussis) per the Childhood Immunization Schedule - 173 NAC 4-004 (Required Levels of Protection), Polio (IPV) - 173 NAC 4-004, Hepatitis B (Hep B) - 173 NAC 4-004, Haemophilus influenzae type b (Hib) - 173 NAC 4-004, Pneumococcal conjugate (PCV) - 173 NAC 4-004, MMR (measles, mumps, rubella) / MMRV - 173 NAC 4-004, Varicella (chickenpox), unless reliable documented history of disease - 173 NAC 4-004, Minimum number of doses of each vaccine is set by the Childhood Immunization Schedule (Attachment 1) incorporated by reference into 173 NAC 4. Medical exemptions (physician/APRN/PA certification) and parental/religious exemptions (written statement) permitted per 391 NAC 3-006.18 and 173 NAC 4. The licensee/director must obtain a copy of each child's immunization record within 30 days of enrollment (391 NAC 3-006.18), and annual reporting to the Department is required per 391 NAC 3-006.18A and 173 NAC 4.

Nevada

Diphtheria, Tetanus, Pertussis, Poliomyelitis (Polio), Rubella, Rubeola (Measles), Mumps, Hepatitis A, Hepatitis B, Varicella (Chickenpox), Streptococcus Pneumoniae (Pneumococcal/PCV), Haemophilus Influenzae type B (Hib), Certificate of immunization required prior to admission per NRS 432A.230 (conditional admission permitted); medical and religious exemptions allowed (per DWSS/DPBH immunization page, requirements apply unless excused because of a religious belief or medical condition)

New Hampshire

Documentation of acceptable immunization required for each child prior to admission to a child care agency, per RSA 141-C:20-a and He-P 301.14 (NH Immunization Requirements rule), Required immunizations conform to the NH DHHS Division of Public Health Services schedule (He-P 301.14), following the ACIP/CDC childhood schedule (e.g., DTaP, IPV/polio, MMR, Hib, hepatitis B, varicella, pneumococcal), Conditional enrollment permitted with documentation of at least one dose of each required vaccine plus the appointment date for the next due dose(s), Medical exemption (licensed physician/health care provider certification) and religious exemption (signed NH Childcare/School Immunization Religious Exemption form) permitted under RSA 141-C:20-c, Health assessment / physical examination record required per He-C 4002.10 (Child Record Requirements)

New Jersey

DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal, Influenza

New Mexico

DTaP/DT/Td (Diphtheria, Tetanus, Pertussis) — required series (4 doses sufficient if 4th dose given on/after 4th birthday with 6-month gap; 5 doses optimal), IPV (Polio) — required series; only IPV is valid for the polio requirement, MMR (Measles, Mumps, Rubella) — required; doses given <12 months are invalid and must be repeated; required 2nd dose should be given on/after 4th birthday, Hib (Haemophilus influenzae type b) — required for CYFD/ECECD-regulated child care and pre-school populations (7.5.2.9.H NMAC), Hepatitis B (HepB) — 3-dose series (2 doses of adult Recombivax HB acceptable per schedule), Pneumococcal conjugate (PCV13/PCV15/PCV20) — required; no doses required at 60+ months, Varicella (chickenpox, VAR) — required; doses given <12 months invalid; 2 doses with min 3-month interval for ages 1-12, Hepatitis A (HepA) — required for CYFD/ECECD-regulated child care/pre-school (7.5.2.9.K NMAC); 1st dose required at 15 months, 2nd dose required at 48 months (>6-month interval), Influenza (recommended every year, 6 months and older) and COVID-19 (recommended 6 months-18 years) are NOT required for child care entry, Only medical or religious exemptions are permitted (NMSA 1978 § 24-5-3; 7.5.3.8 NMAC — 'Requirements for Approval of Exemptions from Immunization'); no philosophical/personal exemption. Documented on a Public Health Division-approved Certificate of Exemption; up to 30-day grace period for foster, homeless, or at-risk children per 8.16.2.22(E)(1)(e) NMAC

New York

DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Pneumococcal, Meningococcal (required per NY Public Health Law)

North Carolina

DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A

North Dakota

Diphtheria, Pertussis (whooping cough), Tetanus, Measles, Rubella (German measles), Mumps, Hepatitis B, Haemophilus influenzae type b (Hib), Varicella (chickenpox), Poliomyelitis (polio), Pneumococcal disease, Meningococcal disease, Rotavirus, Hepatitis A, Age-appropriate immunization required before admission per N.D.C.C. 23-07-17.1 and N.D. Admin. Code ch. 33-06-05 (early childhood/school immunization requirements; proof of immunization or certificate due within 30 calendar days of enrollment for early childhood facilities); medical exemption by licensed physician, or religious/philosophical/moral exemption by parent/guardian certificate, permitted with documentation; verification of immunization or exemption kept on file per N.D. Admin. Code 75-03-10-22(2)(f)

Ohio

DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal

Oklahoma

Hepatitis B (Hep B), Diphtheria, Tetanus & Pertussis (DTaP), Haemophilus influenzae type b (Hib), Polio (IPV), Measles, Mumps & Rubella (MMR), Varicella/Chickenpox (not required if a parent or treating physician statement confirms the child had chickenpox), Pneumococcal conjugate (PCV), Hepatitis A (Hep A), Required per OAC 340 Appendix II (Immunizations) and 10 O.S. § 411; child care immunization mandate is in 10 O.S. § 411 (not § 281.4). Records or a valid OSDH Form ODH 216A exemption (medical/religious/personal) must be maintained; a one-time 30-calendar-day grace period is allowed. Schedule administered per Oklahoma State Department of Health (OSDH).

Oregon

Certified centers must comply with Oregon Health Authority immunization rules per OAR 414-305-0225, which cross-references OAR 333-050-0040 relating to immunization of children (records). OAR 333-050-0050 'Immunization Requirements' is the OHA rule that sets the actual required immunizations., DTaP (Diphtheria, Tetanus, Pertussis), Polio (IPV), MMR (Measles, Mumps, Rubella), Hepatitis B, Hepatitis A, Varicella (Chickenpox), Hib (Haemophilus influenzae type b), Tdap (adolescent booster, per OAR 333-050-0050), Immunization record or valid medical/nonmedical (religious) exemption required; if a child is enrolled in a public or private elementary school, immunizations are not required to be documented by the child care facility (OAR 414-305-0225(1)). Children in foster care or experiencing homelessness may be cared for while parents/guardians take action to comply (OAR 414-305-0225(2)).

Pennsylvania

DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A

Rhode Island

Programs must adopt immunization policies and procedures consistent with the RI Department of Health regulation 216-RICR-30-05-3 (Immunization and Communicable Disease Testing in Preschool, School, Colleges or Universities), per 218-RICR-70-00-1.9(A), Each child must have an immunization record on file (218-RICR-70-00-1.13(F)(7)(d)), Exemption: programs are not required to maintain immunization documentation for children attending public, private, or parochial schools approved by the RI Department of Education (RIDE) (218-RICR-70-00-1.9(A)), 90-day grace period for foster children or children experiencing homelessness to obtain immunization documentation (218-RICR-70-00-1.9(A)), Annual health examination signed by the child's primary care provider also required (218-RICR-70-00-1.9(A)(2)), Staff must complete a Staff Immunization Form (DHS required form)

South Carolina

Current South Carolina Certificate of Immunization (DHEC Form 2740) required in each child's health record — S.C. Code Regs. 114-503.G.(6)(b), Hepatitis B, Diphtheria, Tetanus, Pertussis (DTaP), Polio (IPV), Measles, Mumps, Rubella (MMR), Varicella (chickenpox), Hib (Haemophilus influenzae type b) — one dose at/after 15 months for children 15–59 months not yet age-appropriately complete; not required at age 5+, Pneumococcal Conjugate (PCV) — one dose on/after the 2nd birthday for children 24–59 months not yet age-appropriately complete, Medical and religious exemptions documented on DHEC 2740 per SC DPH/DHEC

South Dakota

REQUIRED (per SDCL 13-28-7.1 / SD Dept. of Health, applies to early childhood programs): Diphtheria, Tetanus, Pertussis (DTaP) — 4+ doses, REQUIRED: Poliovirus (IPV) — 4+ doses, REQUIRED: Measles, Mumps, Rubella (MMR) — 2 doses, REQUIRED: Varicella (chickenpox) — 2 doses, REQUIRED (older entry, age 11/6th grade): Tdap booster and Meningococcal (MCV4), RECOMMENDED, not required: Haemophilus influenzae type b (Hib), RECOMMENDED, not required: Hepatitis B, RECOMMENDED, not required: Hepatitis A, RECOMMENDED, not required: Pneumococcal (PCV), RECOMMENDED, not required: Influenza (annual), HPV, Exemptions: medical contraindication and religious/conscientious objection (Immunization Affidavit, form OLA-106) per ARSD 67:42:17:22

Tennessee

Hepatitis B (HBV), Diphtheria-Tetanus-Pertussis (DTaP; DT if appropriate), Poliomyelitis (IPV or OPV), Haemophilus influenzae type B (Hib) - required for age under 5 only, Pneumococcal conjugate vaccine (PCV) - required for age under 5 only, Measles, Mumps, Rubella (MMR) - 1 dose each, Varicella - 1 dose or credible history of disease, Hepatitis A - 1 dose, required by 18 months of age or older, Documented on the Tennessee Department of Health Official Certificate of Immunization (TennIIS); positive serology with year documented accepted as alternative for measles/mumps/rubella/hepatitis A/hepatitis B/varicella; medical and religious exemptions permitted, Per Tenn. Comp. R. & Regs. 1240-04-01-.08(2)(e), the agency must have the Official Immunization Certificate before accepting any child age 2 months or older

Texas

DTaP, Polio (IPV), Hib, Hepatitis B, MMR, Varicella, Hepatitis A, Pneumococcal, Influenza (annual, 6-59 months)

Utah

DTaP (Diphtheria, Tetanus, Pertussis), Polio (IPV), MMR (Measles, Mumps, Rubella), Hepatitis B, Hepatitis A, Varicella (chickenpox), Haemophilus influenzae type b (Hib), Pneumococcal (PCV), Required per Utah Admin. Code R396-100 (Immunization Rule for Students), specifically R396-100-3 (Required Immunizations); early-childhood/childcare entry requires age-appropriate immunization per ACIP for the listed antigens. Medical, religious, or personal exemptions allowed under Utah Code 53G-9-303 (completed exemption form + education module/health-department consult). (COVID-19, influenza, and rotavirus are recommended but not required.)

Vermont

Each child's file must document the child's current immunization status (Rule 5.1.3), Immunization records must list each immunization administered and its date, updated after each additional dose (Rule 5.1.3), Children in the process of complying per the Vermont recommended immunization schedule must have the required Vermont Department of Health form on file (Rule 5.1.3), Children with a Vermont-allowed exemption must have the required Vermont Department of Health form on file (Rule 5.1.3), Licensee must submit a Vermont Child Care Immunization Report to the VT Dept. of Health, Immunization Office at least once every 365 days, per 18 V.S.A. §§ 1120-1129 (Rule 5.1.4)

Virginia

DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A, Pneumococcal

Washington

DTaP, Polio, MMR, Varicella, Hib, Hepatitis B, Hepatitis A

West Virginia

Diphtheria (DTaP), Tetanus (DTaP), Pertussis / whooping cough (DTaP), Polio (IPV), Measles (MMR), Mumps (MMR), Rubella (MMR), Hepatitis B, Varicella / chickenpox, Haemophilus influenzae type b (Hib) — required for child care entry per WV OEPS Child Care Immunization Guidelines, Pneumococcal conjugate (PCV) — required for child care entry per WV OEPS Child Care Immunization Guidelines, Meningitis (meningococcal) — listed in the compulsory-immunization statute W. Va. Code §16-3-4; primarily a school-grade-entry requirement, applicability to child-care entry varies by the OEPS schedule, Authority: W. Va. Code §16-3-4 (compulsory immunization for school and state-regulated child care; MEDICAL exemptions only — no religious or philosophical exemption); under the current rule §78-1-15.1.a an immunization record or completion plan signed by a licensed health care provider must be on file upon admittance, and §78-1-15.1.b recognizes only a medical (licensed-health-care-provider) exemption

Wisconsin

DTaP/DTP/DT (diphtheria, tetanus, pertussis), Polio (IPV/OPV), MMR (measles, mumps, rubella), Hepatitis B (Hep B), Varicella (chickenpox) - reliable history of disease accepted per DHS 144.03(2)(g), Hib (Haemophilus influenzae type b), PCV (pneumococcal conjugate), Required under the Wisconsin Student Immunization Law and ch. DHS 144 (DHS 144.03 minimum immunization requirements; child care centers must assess/report status of children age 2-4); written evidence due within 30 school days of admission; health/medical waiver under DHS 144.04 and religious or personal-conviction waiver under DHS 144.05

Wyoming

Diphtheria, Tetanus & Pertussis (DTaP), Hepatitis B (HepB), Haemophilus influenzae type b (Hib), Measles, Mumps, and Rubella (MMR), Pneumococcal conjugate (PCV), Polio (IPV), Rotavirus, Varicella (chickenpox), Required and administered per the ACIP Recommended Immunization Schedule, which the Wyoming Department of Health adopts as its mandatory child-care immunization schedule; the specific vaccine roster is set by the WDH/ACIP schedule rather than enumerated in the administrative rule (Ch. 11 Section 16(f) defers to the 'Wyoming Department of Health's mandatory immunization schedule'), Statutory basis: W.S. § 14-4-116 requires children attending child caring facilities to be completely immunized in a manner similar to the school requirement W.S. § 21-4-309; overseen by the Wyoming Department of Health Immunization Unit, Exemptions: only MEDICAL and RELIGIOUS waivers (approved by the State Health Officer or a County Health Officer) are allowed; philosophical/personal-belief exemptions are NOT allowed per Wyoming statute and WDH, Grace period: an additional 60-day grace period may be approved by DFS for a child experiencing homelessness, in foster care, or due to a recent change in family circumstances (Ch. 11 Section 16(f)(i)(A))

Frequently Asked Questions About Daycare Immunization Requirements

What vaccines does a daycare require?: Most licensed daycares are required by their state licensing agency to verify that enrolled children are current on the vaccines required by that state's childcare licensing rules. The vaccines most commonly required across states include DTaP (Diphtheria, Tetanus, Pertussis), Polio (IPV), MMR (Measles, Mumps, Rubella), Varicella, Hib (Haemophilus influenzae type b), Hepatitis B, and Hepatitis A. Many states also require Pneumococcal. The exact list and the number of doses required vary by state — see the state-by-state table below and verify the current schedule with your state health department.
Can parents opt out of daycare immunization requirements?: Exemption policies differ significantly by state. Most states allow medical exemptions when a licensed physician certifies that immunization would be medically contraindicated for a specific child. Many states also allow religious exemptions, and some states permit personal or philosophical belief exemptions. However, several states have tightened their exemption rules in recent years and no longer allow non-medical exemptions. Exemption rules can change by legislative action and vary at the county level in some states. This page reflects general information about childcare licensing requirements — verify your state's current exemption rules with your state health department or licensing office before enrolling a child.
Do daycare staff need vaccines too?: Some states require licensed childcare staff to be current on certain immunizations as a condition of employment or facility licensure. Common staff requirements include annual influenza vaccination, Tdap (Tetanus, Diphtheria, Pertussis booster), MMR, and Varicella. Staff requirements are typically set in the same licensing rules as child requirements. Contact your state's childcare licensing agency for the staff-specific vaccination requirements that apply to your program.
Are immunization records required for enrollment?: Yes, in virtually all states. Licensed childcare facilities are generally required to collect and keep on file a current immunization record for each enrolled child before or within a short period after enrollment. The required documentation is typically a copy of the child's official immunization record as provided by a healthcare provider. Facilities may also be required to submit aggregate immunization data to the state as part of annual licensing compliance. Check your state's licensing rules for the specific documentation and retention requirements.

Keep Researching

All 50-State Data References

Training hours, ratios, fees, inspections, and more — all 50 states.

Browse data →

License Exemptions by State

Which programs are exempt from childcare licensing requirements in each state.

Check exemptions →

Common Daycare Violations

The most frequently cited violations in licensed childcare inspections, by state.

See violations →

Daycare Illness Policy Guide

When to exclude sick children, readmission criteria, and required communicable disease procedures.

Read the guide →

Daycare Rules and Regulations

An overview of federal and state childcare rules every provider needs to know.

Read the guide →

Immunization data is compiled by the TotReady Research Team from published state childcare licensing rules and is provided for general informational purposes only. This is not medical advice and does not constitute a recommendation for or against any vaccination. Immunization schedules and exemption rules change — always verify the current required immunization schedule with your state health department and your pediatrician before making health decisions. TotReady provides information and document templates, not medical or legal advice.