Get Wi F-44192 2020-2025

The WI F-44192 form is an essential child care immunization record required by the State of Wisconsin. This guide will provide you with a comprehensive walkthrough of each section of the form, ensuring all necessary information is accurately submitted.

Follow the steps to complete the WI F-44192 form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the personal data section, input the child's full name, date of birth, and the name of the parent, guardian, or legal custodian. Ensure that all information is printed clearly.
3. Provide the area code and telephone number, followed by the child's address, including street, apartment number, city, state, and zip code.
4. For the immunization history, list the dates the child received the required immunizations for each type, ensuring to fill in each field for every dose. If the child has had chickenpox disease, indicate this in the provided checkbox.
5. Review the compliance data and waivers section. If the child has not met all immunization requirements, check the appropriate box and ensure to sign this section, acknowledging responsibility for obtaining the remaining doses.
6. In the signature section, the parent, guardian, or legal custodian must sign and date the form, ensuring that they attest to the accuracy of the information provided.

Complete the WI F-44192 form online to meet immunization requirements for your child care center.