Compliance Agreement

Hudson Valley

I agree to always maintain a valid license/certification and up to date annual medical documentation while working with Achieve Beyond.

I agree that it is my responsibility to renew my license/certification and submit a valid registration statement or teaching certificate to the Achieve Beyond Credentialing Department. 

I also agree to obtain an Annual Medical Examination form every year from my physician and submit that completed and signed form to the Credentialing Department.

The Annual Medical Examination form must show:

  • Evidence that I do not have disorder that would preclude me from servicing a child
  • Evidence that I am free of communicable disease
  • Annual PPD Test or Chest X-Ray
  • Measles, Mumps, Rubella vaccination
  • Evidence of or documented refusal of the following recommended vaccines: 
    • Hepatitis B
    • Tetanus immunization within the past 10 years
    • Diphtheria
    • Pertussis
    • Varicella
    • Influenza

Compliance Agreement HV
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