Killington Childcare Immunization Forms

Killington Childcare Immunization Forms

For Non-Reoccurring Children
See Requirements Here: Child Care Vaccine Requirements

More Information About Requirements: More Information For Parents
Child Full Name

First NameLast Name
Are You a Parent/Guardian/Caregiver or from a healthcare providers office.

Parent/Guardian/CaregiverHealthcare Provider
Form Upload

Please Follow All Steps to Upload All Information to ensure that it meets VT State Health Guidelines.
Email Address for conformation
example@example.com
Dates In childcare if known
File Upload

Cancelof
Should be Empty:

Form Upload