Health Record Waiver

In compliance with New York State law and Trocaire College policy, students are required to submit the following health records prior to registration: 1. MMR Immunization Records (Measles, Mumps, Rubella) 2. Meningococcal/ Meningitis Vaccine (dated within last 5 years) or annual declination) 3. Trocaire Medical History Form (This form is required by Trocaire College only)

This Waiver of Non-Compliance permits you to register for Spring 2021 classes. Upon your submission of this waiver, Trocaire’s Wellness Center will contact you within 1 business day with information regarding the specific forms you are missing. Failure to return required forms by January 29, 2021, will result in deregistration (your classes being dropped), and you will not be permitted to attend any class, lab, or clinical online or in-person.

Students are asked to submit documents to the Wellness Center by email at [email protected] or by fax to (716) 825-0416. For questions or assistance in accessing forms, please email [email protected] or call (716) 827-2579. For more information, please visit: https://my.trocaire.edu/student-services/health-office/

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By checking this box, typing my name below, and indicating today's date, I am electronically signing this form.

By submitting this waiver, you acknowledge that you are not in compliance with New York State immunization requirements and Trocaire College health record requirements. You understand your responsibility to submit the required health records no later than January 29, 2021. You understand that failure to submit records by the date noted above will deregister you from all classes, labs, and clinical placements.

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Health Records Non-Compliance Waiver