UTAH SCHOOL IMMUNIZATION RECORD - Davis.K12.ut.us 2026

1. Click ‘Get Form’ to open the UTAH SCHOOL IMMUNIZATION RECORD in the editor.
2. Begin by entering the student’s name, gender, and date of birth in the designated fields. Ensure accuracy as this information is crucial for record-keeping.
3. Next, fill in the parent/guardian's name, mailing address, city, zip code, and telephone number. The parent/guardian must also provide their signature to validate the form.
4. Record each vaccine received by the student by entering the month, day, and year in the appropriate boxes for each immunization listed. This includes DTaP, Polio, MMR, and others as specified.
5. Complete the 'SCHOOL AND EARLY CHILDHOOD PROGRAM USE ONLY' section by indicating whether all immunization requirements have been met or if conditional admission applies.
6. If applicable, check any exemptions granted for medical, religious, or personal reasons and ensure proper documentation is attached.
7. Finally, complete the authorized signature section with a date to finalize the form before submission.

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