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Immunization program form 2026

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The Child Care Immunization Form is a mandatory document for children enrolling in child care in Minnesota, requiring proof of immunizations against specific diseases or legal exemptions. Parents must provide vaccination dates or indicate medical or conscientious exemptions. The form includes detailed instructions on required vaccines, exemption procedures, and certification by parents or healthcare providers.

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Click ‘Get Form’ to open the immunization program form in the editor.
Begin by entering the child's name and birthdate at the top of the form. This information is essential for identifying your child’s immunization records.
Fill in the date of enrollment, ensuring it reflects when your child will start attending child care.
In Section 1, choose either Box A or Box B to certify your child's immunization status based on their age and vaccination history.
For each required vaccine listed, enter the dates received in the corresponding boxes. If a vaccine is medically contraindicated, mark 'MED' or 'CO' for conscientious exemptions as applicable.
Complete Section 2 if you are filing for medical or conscientious exemptions, ensuring all necessary signatures are obtained.

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