Texas Child Care Compliance

Daycare Immunization Requirements in Texas

Every vaccine required for enrollment, the DSHS age-based schedule, exemption rules, provisional enrollment, and exactly what needs to be in each child's file when the inspector shows up.

2026 Guide
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Updated April 2026
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25 min read
Table of Contents

The Big Picture: How Immunizations Work in Texas Child Care

In Texas, every child enrolled in a licensed child care center must be up to date on immunizations — or have a valid exemption on file — before they can attend. This is not a suggestion. It is a legal requirement under 25 TAC §97.63 (the immunization rule from the Texas Department of State Health Services) and 26 TAC §746.613 (the minimum standards for child care centers from HHSC).

The Texas Legislature determines which immunizations are required. DSHS (Department of State Health Services) sets the specific schedule and publishes it each year. HHSC (Health and Human Services Commission) enforces compliance through the licensing and inspection process. As a daycare owner, you sit at the intersection of all three.

Here is what that means in practical terms: you must verify that every child in your care has a current immunization record in their file, that the record shows the required vaccines for the child's age, and that the record is properly documented. If a child does not have the required immunizations and does not have a valid exemption, that child cannot be in your care (with narrow exceptions for provisional enrollment, which we cover below).

Key Rule References

25 TAC §97.63 — The DSHS rule that specifies which immunizations are required for child care facilities, pre-K, and schools. This is the source of the vaccine list and dose requirements.

26 TAC §746.613 — The HHSC minimum standard that says each child enrolled in your center "must meet and continue to meet applicable immunization requirements specified by DSHS." Applies to children from birth through age 14.

DSHS Stock No. 6-15 — The official chart titled "Texas Minimum State Vaccine Requirements for Child-Care and Pre-K Facilities" published each school year. This is the document you actually use to verify records.

The Eight Required Vaccines

Texas requires children in child care to be vaccinated against eight diseases (delivered through eight separate vaccine types). These are set by DSHS under 25 TAC §97.63. Here they are, along with what each one protects against:

Diphtheria, Tetanus & Pertussis
DTaP
Protects against three serious bacterial diseases: diphtheria (throat/airway infection), tetanus (lockjaw), and pertussis (whooping cough). Whooping cough is especially dangerous for infants.
Up to 4 doses by age 19 months
Polio
IPV
Protects against poliovirus, which can cause paralysis and death. Given as inactivated polio vaccine (IPV) by injection. OPV (oral) doses given in other countries are also accepted.
Up to 3 doses by age 19 months
Hepatitis B
HepB
Protects against the hepatitis B virus, which attacks the liver and can cause chronic infection, liver damage, and liver cancer. The first dose is typically given at birth.
3 doses to complete series
Haemophilus influenzae type b
Hib
Protects against Hib bacteria, which can cause meningitis, pneumonia, and epiglottitis (a severe throat infection that blocks the airway). Most dangerous for children under 5.
Up to 3–4 doses depending on vaccine brand
Pneumococcal
PCV
Protects against Streptococcus pneumoniae bacteria, which cause pneumonia, meningitis, and ear infections. Given as pneumococcal conjugate vaccine (PCV13 or PCV15).
Up to 4 doses; fewer if started late
Measles, Mumps & Rubella
MMR
Protects against three viral diseases: measles (rash, fever, can be fatal), mumps (swollen glands, can cause deafness), and rubella (German measles, dangerous during pregnancy).
1 dose on or after 1st birthday
Varicella (Chickenpox)
VAR
Protects against the varicella-zoster virus, which causes chickenpox — an itchy, blistering rash that can lead to serious complications including skin infections, pneumonia, and encephalitis.
1 dose on or after 1st birthday
Hepatitis A
HepA
Protects against the hepatitis A virus, which causes liver inflammation, jaundice, fatigue, and stomach pain. Spreads easily through contaminated food and close personal contact.
1 dose on or after 1st birthday; 2 total to complete series
What About Rotavirus?

Rotavirus vaccine is recommended by the CDC but is not required by Texas DSHS for child care enrollment. It does not appear on the Texas Minimum State Vaccine Requirements chart (Stock No. 6-15). Some pediatricians include it on immunization records since it is part of the routine CDC schedule, but you do not need to check for it during enrollment verification.

Meningococcal Vaccine

Meningococcal vaccine (MenACWY) is not required for child care or pre-K. It becomes a requirement starting in 7th grade (one dose on or after the 11th birthday). You do not need to check for it in your younger children's records.

Required Doses by Age at Enrollment

Texas DSHS publishes the "Minimum State Vaccine Requirements for Child-Care and Pre-K Facilities" chart each school year (Stock No. 6-15). This chart shows exactly how many doses of each vaccine a child must have received based on their current age. The age milestones used are: by 3 months, by 5 months, by 7 months, by 16 months, by 19 months, and by 43 months (3 years, 7 months).

When a child enrolls (or when you review records), you compare the child's age against this chart. The child must have at least the number of doses shown for their age group.

The 4-Day Grace Rule

Vaccines administered up to 4 days before the minimum required age are considered valid under Texas rules. So if a dose is required "on or after the first birthday" and it was given 4 days before the child turned 1, it still counts.

Minimum Doses Required by Age — 2025–2026 School Year

Tip: Print this table and keep it at your front desk for quick reference during enrollment.

Vaccine By 3 mo. By 5 mo. By 7 mo. By 16 mo. By 19 mo. By 43 mo.
DTaP 1 2 3 3 4 4
Polio (IPV) 1 2 2 3 3 3
Hepatitis B 1 2 2 3 3 3
Hib 1 2 2 3 3 3
PCV 1 2 2 3 4 4
MMR — — — 1* 1* 1*
Varicella — — — 1* 1* 1*
Hepatitis A — — — 1* 1* 1*

* = First dose must be given on or after the child's first birthday. For MMR, Varicella, and Hepatitis A, the "by 16 months" requirement only applies to children who have turned 12 months old. A child younger than 12 months is not yet due for these vaccines.

How to Read This Table

If a 10-month-old enrolls, look at the "By 16 mo." column (the next milestone). That child needs at least 3 DTaP, 2 Polio, 2 Hep B, 2 Hib, and 2 PCV — but does not yet need MMR, Varicella, or Hep A (those start at 12 months).

If a 2-year-old enrolls, look at the "By 43 mo." column. That child needs 4 DTaP, 3 Polio, 3 Hep B, 3 Hib, 4 PCV, 1 MMR, 1 Varicella, and 1 Hep A.

Vaccine-by-Vaccine Details and Special Rules

Most vaccines follow the standard schedule above, but several have Texas-specific notes that matter when you are verifying a child's record.

DTaP (Diphtheria, Tetanus, Pertussis)

A child needs four doses by 19 months. The typical schedule is doses at 2, 4, 6, and 15–18 months. A fifth dose is given at 4–6 years for kindergarten entry, but for child care and pre-K purposes, four doses is the maximum required. If a child received DTP (the older whole-cell version) instead of DTaP, those doses still count.

Polio (IPV/OPV)

Three doses are required by 19 months. Either IPV (inactivated, given by injection) or OPV (oral, used in some other countries) are acceptable. If a child received a mix of IPV and OPV, all valid doses count toward the total.

Hepatitis B

Three doses are required. The first dose is typically given at birth, the second at 1 month, and the third at 6 months. The third dose must be given at 24 weeks of age or older to be counted. If a child received a combination vaccine that included Hep B (such as Pediarix), those doses count.

Hib (Haemophilus influenzae type b)

This one has special rules because different Hib vaccine brands have different dose schedules:

When verifying Hib records, check whether the child received 3 or 4 doses depending on the brand used. If you cannot identify the brand, 3 doses with at least one after 12 months is generally sufficient.

PCV (Pneumococcal Conjugate)

The standard series is 4 doses (at 2, 4, 6, and 12–15 months). However, the number of required doses decreases if the series is started late:

PCV13 (Prevnar 13) and PCV15 (Vaxneuvance) are both acceptable. PCV20 (Prevnar 20) is also acceptable if administered per the current CDC schedule.

MMR (Measles, Mumps, Rubella)

One dose is required for child care, and it must be given on or after the child's first birthday. A second dose is required for kindergarten entry but not for child care or pre-K. Serologic evidence of immunity (a blood test showing antibodies) is accepted as an alternative to vaccination for each individual disease.

Varicella (Chickenpox)

One dose is required for child care, given on or after the first birthday. A second dose is required for kindergarten entry. A written statement from a physician confirming that the child has had chickenpox disease (including the approximate date) is accepted as an alternative to vaccination. Serologic evidence of immunity is also accepted.

Hepatitis A

One dose is required for child care, given on or after the first birthday. A second dose (given at least 6 months after the first) completes the series, but only one dose is required at the child care level. This requirement has been in effect since the 2022–2023 school year.

What Documentation Is Accepted

You cannot just take a parent's word for it. Texas requires specific documentation of immunizations. Under 25 TAC §97.63, acceptable documentation means:

Common Documentation Problems

Missing dates: A record that says "DTaP — complete" without showing the month, day, and year of each dose is not acceptable. You need the specific date of every dose.

No provider validation: A parent-completed form or a handwritten list from a parent is not valid documentation. It must come from a physician, clinic, or public health authority.

Expired records: Immunization records do not "expire" the way CPR cards do. However, if a child's record shows they were due for a dose months ago and have not received it, the child is out of compliance.

ImmTrac2: The Texas Immunization Registry

ImmTrac2 is the state's centralized immunization registry, operated by DSHS at no cost. It consolidates immunization records from healthcare providers across Texas into a single database. If a child's parent has consented to participate in the registry, the child's complete immunization history is accessible online.

How It Helps Daycare Operators

Can Daycare Providers Access It?

Yes. Texas law authorizes child care facilities to access immunization records in ImmTrac2 for children enrolled at their facility. To get access, you must:

  1. Register as an Authorized Organization through the ImmTrac2 online registration form at immtrac.dshs.texas.gov.
  2. Designate authorized users at your facility who will have login access to the system.
  3. Renew your registration every two years by logging in and selecting the renewal option.

For registration help, contact the Texas Immunization Registry Customer Service at (800) 348-9158.

Consent Is Required

ImmTrac2 only contains records for individuals whose parent or guardian has consented to participate. Not every child will be in the system. If a child is not in ImmTrac2, you still need to obtain a physical immunization record from the parent. The consent form is DSHS Stock No. C-7 ("Texas Immunization Registry Minor Consent Form").

Immunization Exemptions in Texas

Texas law allows three types of exemptions from immunization requirements. As a daycare owner, you need to understand all three because any one of them can appear in a child's file in place of immunization records.

1. Medical Exemption

A licensed physician (MD or DO) provides a signed statement that a specific vaccine is medically contraindicated for the child — meaning the vaccine would be harmful to the child's health.

  • Must be signed by the physician
  • Must specify which vaccines are contraindicated
  • Valid for one year unless the physician states the condition is lifelong
  • Must be renewed annually if temporary
2. Conscience/Religious Exemption

Texas allows parents to exempt their child from any or all immunizations for "reasons of conscience, including religious beliefs." This is sometimes called a "personal belief exemption."

  • Requires the official DSHS affidavit form
  • Must be signed and notarized
  • Valid for two years from the notarization date
  • Must be renewed before it expires
3. Military Exemption

Active-duty members of the U.S. Armed Forces are exempt from immunization requirements. For child care purposes, this rarely applies to the children themselves, but dependents of active-duty personnel may have delayed records due to transfers.

  • Military ID or orders can serve as documentation
  • Children of military families are often provisionally enrolled while records transfer
Texas Is More Permissive Than Most States

Texas's conscience exemption policy is broader than many other states. Some states only allow religious exemptions; others require medical exemptions only. Texas allows exemption for any reason of conscience, including but not limited to religious beliefs. A parent does not need to explain or justify their reason beyond completing the affidavit form. This means you will likely encounter exemption affidavits in your enrollment files. The important thing for you, as the operator, is that the correct form is on file, it is properly notarized, and it has not expired.

The Conscience Exemption Process (Step by Step)

Because this is the exemption type you will encounter most often, here is exactly how it works:

  1. The parent obtains the official affidavit form from DSHS. As of September 1, 2025, the form can be downloaded directly from the DSHS website. It can also be requested by mail (DSHS, Immunization Branch, PO Box 149347, Austin, TX 78714), by fax (512-776-7544), or in person at DSHS offices at 1100 West 49th Street, Austin, TX 78756. The online request portal is at co-request.dshs.texas.gov. DSHS does not accept phone or email requests.
  2. The parent completes the form. It must include the child's full name and date of birth, and indicate which immunizations are being declined.
  3. The parent signs the form and has it notarized. A notary public must witness the parent's signature and apply their seal. This cannot be skipped. An un-notarized form is not valid.
  4. The parent submits the completed, notarized affidavit to your daycare. You place it in the child's file.
  5. You verify the form: Check that it is the official DSHS form (Stock No. F11-11755), that it is fully filled out, signed, notarized, and that the notarization date is within the last two years.
Two-Year Expiration

The exemption affidavit is valid for two years from the notarization date, not from the date it was submitted to you. If it expires while the child is enrolled, the child is out of compliance until a new affidavit is filed or the child receives the immunizations. Track these expiration dates the same way you track CPR card expirations for staff.

Outbreak Exclusion Rule

Even with a valid exemption on file, a child may be excluded from your facility during a disease outbreak. If there is an official emergency or outbreak declared by the local or state health department, you can (and may be required to) temporarily exclude unimmunized children until the outbreak is resolved. This applies to all exemption types — medical, conscience, and military.

What the Exemption Form Looks Like

The official form is titled "Affidavit Request for Exemption from Immunizations for Reasons of Conscience" and carries DSHS Stock No. F11-11755. It is a single-page form that includes:

If a parent hands you a form that does not look like the official DSHS affidavit — for example, a self-written letter or a form from a third-party website — it is not valid. Only the official DSHS form is accepted.

Provisional Enrollment: When a Child Is Catching Up

Not every child will have a complete immunization record on day one. Texas allows provisional enrollment under specific conditions, so a child can start attending while they catch up on vaccines. Here is how it works:

Who Qualifies for Provisional Enrollment

The 30-Day Review Cycle

Provisional enrollment is not open-ended. Here is your obligation:

Practical Tip

When you provisionally enroll a child, document it. Note the date of provisional enrollment, which vaccines are still needed, and when the next dose is due. Set a calendar reminder for the 30-day review. Keep a copy of whatever partial records you do have. This documentation protects you during inspection — it shows you are actively managing the catch-up process rather than ignoring a gap.

Children Without Any Records

A child who has no immunization records at all and no exemption on file cannot be enrolled — not even provisionally — unless they fall into the homeless or foster care category. For all other children, the parent must at minimum provide evidence that the child has received at least the first dose in the series, or obtain a valid exemption, before the child can start attending.

What the Inspector Checks (Form 7260)

During a licensing inspection, the HHSC licensing representative uses Form 7260 — Children's Records Evaluation to review children's files. Immunization records are one of the key items checked in every child's file.

Here Is What the Inspector Verifies

FORM 7260 Children's Records Evaluation of Child Care Centers

This is the evaluation form your inspector uses to review children's files. Section by section, it checks personal information, emergency contacts, health statements, immunization records, and pick-up authorization. Immunization compliance is typically one of the first things checked. A missing or incomplete immunization record = an immediate deficiency.

Common Immunization Deficiencies Found During Inspection

Deficiency What Happened How to Prevent It
Missing immunization record No immunization documentation of any kind in the child's file Never complete enrollment without either an immunization record or valid exemption in hand
Record missing dates Record shows vaccine names but not the month/day/year of administration When collecting records at enrollment, check for dates on every dose before accepting the document
Child has aged past a milestone Child was compliant at enrollment but has since turned 19 months (or 43 months) and now needs additional doses that are not on file Review immunization records whenever a child passes an age milestone; request updated records from parents
Expired exemption affidavit The two-year validity period has passed and no renewal was filed Track exemption expiration dates; notify parents 60 days before expiration
Unofficial exemption form Parent submitted a self-written letter or non-DSHS form instead of the official affidavit Only accept DSHS Stock No. F11-11755; educate parents about the process during enrollment
No provider validation Record appears to be parent-completed or lacks a physician signature/stamp Verify that every record has a provider signature, stamp, or initials before filing
Deficiency = Compliance History

Every immunization deficiency cited during inspection becomes part of your public compliance history, searchable online at childcare.hhs.texas.gov. Parents can and do check these records. One missing immunization record might seem minor in the moment, but it shows up on your public record alongside everything else.

Staff Immunization and Health Requirements

Texas does not mandate a specific list of vaccines for child care center employees the way it does for the children. However, there are important requirements to know about.

Vaccine-Preventable Disease Policy (HRC §42.04305)

Under Texas Human Resources Code §42.04305, every licensed child care facility (other than a home-based facility) must develop and implement a written policy to protect children from vaccine-preventable diseases. This policy must:

In other words: you choose which vaccines to require for your staff, but you must have a written policy and you must follow it. The policy should be specific (for example: "All employees who have direct contact with children must provide documentation of influenza vaccination annually, or submit a signed declination form").

Tuberculosis (TB) Screening

TB screening requirements for child care employees in Texas vary by local jurisdiction. Under the regulatory framework:

Note on TB Screening Changes

HHSC rescinded Provider Letter PL 2024-20 regarding TB screening and testing requirements in November 2024. Updated guidance has been forthcoming. Check the HHSC Provider News page for the latest updates on TB screening policy for child care employees.

Immunization File Checklist: What Should Be in Every Child's File

Here is a practical checklist of what should be in each child's file related to immunizations. Use this during enrollment and during your monthly self-audits.

For Every Child (one of the following):
  • Current immunization record showing month/day/year of each dose, validated by a physician or public health authority — meeting the DSHS minimum requirements for the child's current age
  • OR: Official DSHS exemption affidavit (Stock No. F11-11755), properly completed, signed, notarized, and within its two-year validity period
  • OR: Medical exemption letter signed by a licensed physician, specifying which vaccines are contraindicated and stating whether the condition is temporary or permanent
  • OR: Provisional enrollment documentation showing which vaccines have been received, which are still needed, the date of provisional enrollment, and evidence of the 30-day review cycle
Additional Items to Track:
  • Date of next dose due (if on a catch-up schedule)
  • Exemption affidavit expiration date (if applicable)
  • Medical exemption renewal date (if temporary condition)
  • ImmTrac2 consent form (if parent has consented to registry participation)
  • Record of when immunization records were last reviewed/updated
Build a System, Not a Scramble

The best daycare operators do not check immunization compliance only when the inspector shows up or only at enrollment. They build a system: review records at enrollment, flag children approaching age milestones, track exemption expiration dates, and conduct monthly spot audits of 3–5 random files. When you have a system, the inspection is just confirmation of what you already know.

Official Texas Resources

Everything in this guide is based on official Texas DSHS, HHSC, and regulatory sources. Here are the direct links you should bookmark:

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