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04 Wis. Stats. DAY CARE IMMUNIZATION RECORD COMPLETE AND RETURN TO DAY CARE CENTER. State law requires all children in day care centers to present evidence of immunization against certain diseases within 30 school days 6 calendar weeks of admission to the day care center. See Waivers below. If you have any questions on immunizations or how to complete this form please contact your child s day care provider or your local health department. PERSONAL DATA STEP 1 PLEASE PRINT Child s Name Last First Middle Initial Date of Birth Month/Day/Year Area Code/Telephone Number Name of Parent/Guardian/Legal Custodian Last First Middle Initial Address Street Apartment number City State Zip IMMUNIZATION HISTORY STEP 2 List the MONTH DAY AND YEAR the child received each of the following immunizations. DO NOT USE A 4 OR X except to indicate whether the child has had chickenpox. If you do not have an immunization record for this child contact your doctor or local public health department to obtain the r....

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Related content

Child Care Immunization Record - Wisconsin...
F-44192 (Rev. 12/2017). CHILD CARE IMMUNIZATION RECORD. STATE OF WISCONSIN. Wis. Stat. §...
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Child Care Immunization Record - Wisconsin...
F-44192 (Rev. 12/2017). CHILD CARE IMMUNIZATION RECORD. STATE OF WISCONSIN. Wis. Stat. §...
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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
WI F-44192
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