Follow the steps to complete the form successfully.

1. Press the 'Get Form' button to access the Maryland Immunization Certification Form and open it in your preferred editing tool.
2. Begin by filling in the child's name in the appropriate fields — last name, first name, and middle initial. Ensure to enter the birthdate using the month/day/year format.
3. Indicate the county of residence and the school's name alongside the grade level of the child.
4. Provide the parent or guardian's name and complete their address, including city and ZIP code. Ensure to include a valid phone number for contact purposes.
5. For the record of immunizations, list the required vaccines by selecting the vaccine type. Document each dose number and provide the corresponding administration dates in the month/day/year format.
6. If applicable, provide details about a history of varicella disease and any relevant medical contraindications or religious objections in the designated sections, ensuring that signs and dates are added.
7. Have a medical provider or authorized official complete the certification section by providing their signature, title, and date, thereby confirming the vaccination record.
8. Review the entire form for completeness and accuracy. Once finalized, you may save your changes, download the document, print it, or share it as required.

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