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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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2013	4.9 Satisfied (43 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Does my high school still have my immunization records?

Most schools keep vaccination records on file. Schools may keep records for a year or two after a student leaves or graduates. Contact your childs school for more information.

How do you document that you administered the immunization?

All vaccines administered should be fully documented in the patients permanent medical record. Health care providers who administer vaccines that are covered by the National Vaccine Injury Compensation Program are required by law to ensure the permanent medical record of the recipient indicates: Date of administration.

How to show proof of immunity?

There are two ways to verify immunization history: Vaccination records from health care providers: Confirm when, where and by whom certain vaccines were administered. When these records are unavailable: Results of a blood titer test can provide the documentation that a school or workplace may need.

How do I find out if my child has had all their vaccinations?

All vaccinations given before your child is of school age should be recorded in your childs Red Book. If your child was vaccinated in school in the last 3 years you will have received an email from school.immunisations@nhs.net, notifying you of the vaccine given, this may have gone to your junk folder.

What is the immunization form?

Vaccination records (sometimes called immunization records) provide a history of all the vaccines you or your child received. This record may be required for certain jobs, travel abroad, or school registration.

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