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COMMONWEALTH OF KENTUCKY IMMUNIZATION CERTIFICATE - beta calloway kyschools 2025

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The document is an Immunization Certificate required for children enrolled in various childcare and educational facilities in Kentucky. It includes sections for the child's personal information, immunization dates for several vaccines, and a certification statement from a healthcare provider confirming the child's immunization status. The certificate must be presented to the enrolling institution and retained as part of the child's health record.

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Click ‘Get Form’ to open the COMMONWEALTH OF KENTUCKY IMMUNIZATION CERTIFICATE in the editor.
Begin by entering the child's name in the designated fields for Last, First, and Middle names, followed by their birthdate.
Next, fill in the name of the parent or guardian and their address, ensuring all details are accurate for proper identification.
Proceed to document the dates of immunizations administered. For each vaccine listed (Diphtheria, Tetanus, Pertussis; Hib; PCV; Polio; Hepatitis B; MMR; Varicella; Tdap; Meningococcal), enter the date in MM/DD/YYYY format for each dose received.
Indicate if the child has had chickenpox or zoster disease by marking the appropriate box. Ensure that all required signatures are completed at the bottom of the form.
Finally, review all entered information for accuracy before saving or printing your completed certificate.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (105 Votes)
2017	4.4 Satisfied (113 Votes)
2010	4.3 Satisfied (159 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.

Can I get a copy of my immunization records online in KY?

Access your or your minors official immunization record through the secure Kentucky Immunization Registry (KYIR) Public Portal, a free service of the Kentucky Department for Public Health that allows individuals, parents and legal guardians to access official immunization records from KYIR

How can I get my old immunization records?

Healthcare employees must keep the records of minors at least seven years after the most recent discharge date or one year after the patient turns 18 (whichever is longer).

How to get a religious exemption for vaccines in KY?

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.

How long do doctors keep immunization records?

Required Immunizations in Kentucky Five doses of DTaP or DTP (diphtheria, tetanus, pertussis) or combinations of the two vaccines. Four doses of IPV or OPV (polio) or combinations of the two vaccines. Three doses of hepatitis B. Two doses of MMR (measles, mumps, rubella).