Kentucky immunization certificate 2026

1. Click ‘Get Form’ to open the Kentucky Immunization Certificate in the editor.
2. Begin by entering the child's name, birthdate, and parent's name in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the address of the parent or guardian, including street, city, state, and zip code. This helps maintain proper records.
4. In the vaccine section, check off each vaccine received by the child. For each vaccine listed, enter the corresponding dates for doses 1 through 5.
5. Indicate if the child has had Chickenpox or Zoster Disease by selecting 'Yes' or 'No'.
6. Select whether the child is current on immunizations and provide a reason if they are not up-to-date. Fill in any necessary details regarding medical exemptions or provisional status.
7. Finally, ensure that a qualified individual certifies the document by signing and dating it at the bottom of the form.

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