Certificate of Immunization Status form - Washington State ... - mgaes 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your child’s last name, first name, middle initial, birthdate (MM/DD/YY), and sex in the designated fields.
3. Provide permission for your child’s school to share immunization information by checking the appropriate box.
4. Fill in the vaccine information by writing the date of each vaccine dose received in the corresponding date columns. Use the reference guides for accurate recording of combination vaccines.
5. If applicable, have a healthcare provider verify any history of Varicella disease and sign where indicated.
6. Complete the Documentation of Disease Immunity section if your child has positive immunity verified by blood tests, ensuring lab reports are attached.
7. Finally, ensure both parent/guardian signatures are provided along with dates before submitting the form.

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