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Ky immunization certificate

Kentucky immunization certificate 2026

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4.4 out of 5

113 votes

The document is a Certificate of Immunization Status for children in the Commonwealth of Kentucky, detailing the child's immunization records, including vaccines received and their dates. It includes sections for personal information about the child and parent, vaccination status, and certification by a healthcare provider. The certificate indicates whether the child is current on immunizations or not, along with reasons for any delays. It is intended for presentation to schools or facilities for enrollment purposes.

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Click ‘Get Form’ to open the Kentucky Immunization Certificate in the editor.
Begin by entering the child's name, including last, first, middle, and suffix. Next, input the birthdate in MM/DD/YYYY format.
Fill in the parent's name and address details, ensuring accuracy for effective communication.
In the vaccine section, mark each vaccine received by the child. For each dose, enter the date administered in MM/DD/YYYY format.
Indicate if the child has had Chickenpox or Zoster Disease by selecting 'Yes' or 'No'.
Complete the certification section by having a qualified individual sign and date it to validate immunization status.

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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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