Download this form, complete and sign both pages prior to your arrival at an immunization clinic or the Public Health Department. Bring the completed form and your immunization record with you.
Caregiver Consent
If you are unable to accompany your child to an Immunization Clinic, please download, complete and sign the Immunization Consent Form and the Caregiver Consent or Designation of another Person to Consent for Immunizations below. Have the caregiver bring both completed forms and the child's immunization records with them to the clinic!
