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COMMONWEALTH OF KENTUCKY IMMUNIZATION CERTIFICATE - beta calloway kyschools 2026
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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. Then, input the birthdate in the provided format.
- Next, fill in the name of the parent or guardian along with their address, ensuring all details are accurate for effective communication.
- Proceed to document the dates immunizations were administered. For each vaccine listed (Diphtheria, Tetanus, Pertussis; Hib; PCV; Polio; Hepatitis B; MMR; Varicella; Tdap; Meningococcal), enter the corresponding dates in MM/DD/YYYY format.
- Indicate if the child has had chickenpox or zoster disease by marking 'X' in the appropriate box. Ensure all sections are completed before finalizing.
- Finally, have a licensed healthcare professional sign and date the certificate. This signature is crucial for validation.
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