Hilltop preschool 2026

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The document is a Provisional Immunization Certificate for children in Kentucky, detailing the required immunizations administered to a child, including Diphtheria, Tetanus, Pertussis, Hib, PCV, Polio, Hepatitis B, MMR, Varicella, Tdap, and Meningococcal. It includes sections for the child's and parent's information, dates of immunizations, and certification by a healthcare provider. The certificate is valid for 14 days after the next shot is due and must be presented to schools or facilities for enrollment.

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Click ‘Get Form’ to open the hilltop preschool document in the editor.
Begin by entering the child's name in the designated fields for Last, First, and Middle names. Next, input the birthdate in the provided format.
Fill in the name of the parent or guardian, followed by their address details including street, city, state, and zip code.
For each immunization type listed (Diphtheria, Tetanus, Pertussis; Hib; PCV; Polio; Hepatitis B; MMR; Varicella; Tdap; Meningococcal), enter the dates administered in the Month/Day/Year format. Ensure all relevant doses are recorded.
If applicable, indicate if the child has had chickenpox or zoster disease by marking 'X' in the appropriate section.
Finally, ensure that a qualified individual signs and dates the certificate at the bottom before submission.

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