Get Child Immunization Record

Filling out the Child Immunization Record is an important step to ensure your child's enrollment in child care. This guide provides a clear, step-by-step approach to navigate the online form accurately and efficiently.

Follow the steps to complete the Child Immunization Record.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Enter the child's name in the designated field labeled 'Name.'. This should be the full legal name of the child.
3. Fill in the child's birthdate in the format 'MM/DD/YYYY' in the 'Birthdate' field. Ensure the date is accurate to verify the child's age.
4. Input the 'Date of Enrollment' in the same format as the birthdate. This records when the child is officially enrolled in child care.
5. Proceed to the 'Immunization History' section. Fill in the appropriate dates for each vaccine administered according to the child's vaccination schedule. Ensure each entry is accurate, using the established intervals recommended for each vaccine.
6. If the child has received combined vaccinations (like Hib-hep B), write the vaccination date in all applicable boxes.
7. Ensure to have a certified signature from either the parent/guardian, physician, or a public clinic representative in the designated signature field, along with the date of signing. Indicate which section is being certified based on the child's age and vaccination status.
8. Review all filled sections for any errors or missing information before finalizing. Ensure that all required vaccinations are documented correctly as per the law.
9. Once completed, save your changes. You can then download, print, or share the completed form as needed.

Ensure your child is compliant with immunization requirements by filling out the Child Immunization Record online today.