Kci certificate pdf form 2026

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The Kansas Certificate of Immunizations (KCI) is a mandatory record for students that documents their vaccination history as required by Kansas School Immunization Law. It includes details such as the student's name, address, and vaccination records for various diseases necessary for school entry. The document outlines specific immunization requirements based on age and grade levels, including exemptions for medical or religious reasons. Additionally, it provides guidelines for maintaining accurate vaccination records and the consequences of non-compliance.

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Click ‘Get Form’ to open the KCI Certificate of Immunizations in the editor.
Begin by entering the student's name and address in the designated fields. Ensure accuracy as this information is crucial for record-keeping.
Fill in the parent or guardian's name, phone number, and birthdate of the student in the respective sections.
Record each vaccine dose received by entering the date in the 'RECORD THE MONTH, DAY, AND YEAR THAT EACH DOSE OF VACCINE WAS RECEIVED' section. Be sure to check which vaccines are required for school entry.
If applicable, indicate any medical exemptions by providing a physician's signature and agency details at the bottom of the form.
Review all entered information for accuracy before saving or exporting your completed form.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (133 Votes)
2018	4.3 Satisfied (23 Votes)
2013	4.4 Satisfied (336 Votes)

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