Get Immunization History Form - Little Rascals

Completing the Immunization History Form is an essential step in ensuring your child's health and compliance with school and childcare requirements. This guide provides clear, step-by-step instructions on how to fill out the form accurately and submit it efficiently online.

Follow the steps to complete your child's immunization history form online.

1. Press the ‘Get Form’ button to obtain the Immunization History Form and open it in the online editor.
2. Fill in the school or childcare facility's name where your child is enrolled.
3. Provide your child's full name, including surname, given name, and preferred name if applicable. Ensure to include the correct birthdate in the format of day, month, and year.
4. Enter the child’s personal health number, home address, and postal code for accurate record-keeping.
5. Complete the section for parental information, including both parents' names and contact numbers for effective communication.
6. Indicate whether your child has had chicken pox by selecting 'Yes', 'No', or 'Don't know' by checking the appropriate box.
7. Attach a photocopy of your child's immunization record. If you do not have a record, you can manually fill in the immunization details with the corresponding dates.
8. For each vaccination listed, fill in the date it was given. This includes vaccinations for diphtheria, pertussis, tetanus, and others as specified in the form.
9. Once all necessary fields are completed, review the form to ensure all information is accurate and legible.
10. After verifying the details, proceed to save your changes. You can then download, print, or share the completed form as needed.

Ensure your child's immunization history is submitted accurately by completing the form online today.