Get Mn 140-0652 2011-2025

The MN 140-0652 form is essential for documenting a student's vaccination records in Minnesota. This guide provides clear and comprehensive instructions on how to fill out the form correctly while using an online format.

Follow the steps to complete your MN 140-0652 form online.

1. Press the ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by entering the student's full name in the designated field.
3. Next, provide the student's date of birth in the appropriate format.
4. Enter the student's unique identification number in the specified field.
5. For school use only, select the appropriate vaccination status by checking the corresponding box regarding whether vaccinations are complete, in process, or if there are any medical or conscientious objections.
6. Input the dates of the vaccinations the student has received, filling in the month, day, and year for each dose listed under the required and recommended vaccines.
7. If applicable, indicate any exceptions by providing necessary details as stated on the form.
8. Parents or guardians should certify the accuracy of the vaccination information by signing and dating the form.
9. Complete the parental consent section if you agree to share the vaccination record with the Minnesota immunization registry.
10. If applying for a medical exemption, ensure that the relevant medical professional signs and dates the declaration. For conscientious objections, complete the required statement in the presence of a notary.
11. Once all sections are filled out, review the information for accuracy. Save the form, download it for your records, or print it as needed.

Complete your MN 140-0652 document online today for a smooth vaccination record submission.