Child Care Immunization Form Requirements

The MDH regulations governing the licensure of child care facilities mandate that each child in a licensed facility have immunizations according to the recommended immunization schedule. All children must have one of the following forms before enrollment in a licensed child care facility.

• Certificate of Immunization Compliance (Form 121). This form MUST be signed by the District Medical Director, a physician, nurse, or designee.
• Certificate of Medical Exemption (Form 122). This form must be signed by the District Medical Director.