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Immunization Form

The "Certificate of Immunization Status"  form is to be used by licensed providers. The form does not need to be the green, hardcopy record.  A photocopy or printed version is acceptable.

Licensors and providers must check to be sure that both sides of the form are copied/printed, since the portion for parents to sign is on the second page of the form.

WA State Lifetime Immunization Record (PDF file)

You can find Child Development, Health & Safety publications on the WA State Dept. of Early Learning web site.

Varicella (Chicken Pox) Immunization Required

Beginning July 1, 2006, children from age 19 months up to kindergarten need to be vaccinated, have documented history of disease of a positive serology or be exempted from the immunization. Children entering kindergarten and sixth grade for the 2006-07 school year must prove their immunity to varicella. The Department of Health encourages verifying varicella immunity status for all children in grades Kindergarten to sixth.

Local Resources

State Resources

  • Child Profile - CHILD Profile is Washington State's health promotion and immunization registry system designed to help ensure that Washington's children receive the preventive health care they need.
  • Children's Hospital & Regional Medical Center (Seattle) -Children's hospital has been caring for kids for over 90 years. As the premier pediatric referral center for the Pacific Northwest, we're the recognized experts in the specialized health care of children. We understand their unique needs--they're not just little adults.
  • Healthy Child Care Washington believes every child deserves to live in an emotionally- and physically-healthy environment. A child’s well-being is dependent on the knowledge, involvement, and commitment of the caregivers and health professionals in their lives.
  • Mary Bridge Children's Hospital (Tacoma)- We believe that families play a pivotal role in the health and well-being of the children, and we recognize and support that role. Because children are so dependent on their parents and family, Mary Bridge encourages families to be part of their children's health care team.
  • Washington State Department of Health - Get information on current health topics, agency programs and health alerts for Washington State.
  • Washington State Medical Home: a coordinated health care partnership between a child, his or her parents and the child's primary care doctor.
  • Within Reach (formerly Healthy Mothers, Healthy Babies) The Within Reach  provides essential resources for family health.
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