Pupil Immunization Record, English - Minnesota Dept of Health Form for parents to record a child's s 2025

1. Click ‘Get Form’ to open it in the editor.
2. 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.
3. In the vaccine section, fill in the dates (MONTH, DAY, YEAR) for each dose received. Ensure you do not use checkmarks; instead, write the exact dates as required.
4. If applicable, complete the medical exemption section by having a physician sign and date it if your child has a medical contraindication.
5. For conscientious exemptions, ensure that you complete and notarize the statement provided on the form regarding your beliefs against immunization.
6. Finally, review all entries for accuracy before saving or printing your completed form. This ensures that all necessary information is correctly documented.

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