Health Unit

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Child Immunization Form

Children attending school or day care in Ontario must be immunized for certain diseases under the Immunization of School Pupils Act or the Day Nurseries Act. If parents choose not to have their child immunized they must submit the appropriate exemption form--for medical reasons or for conscience or religious beliefs.

The Health Unit is required to collect and maintain up-to-date records of immunization for every child registered in school or day care in Simcoe County and Muskoka District.

Please provide the following details for our records. The information will be reviewed within 5 business days. You may be contacted at a later date, to confirm the information. Privacy Policy.

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Please note required fields are marked with an *Asterisk.

Contact Details
Child Information
Immunization Records

Using the yellow card below, select all of the vaccines given on the date entered in the first line of the card. You can select the vaccine individually or select by vaccine brand name. To enter multiple vaccination dates, click the Add Yellow Card button. You can use up to 10 Yellow cards.

Please ensure that the information submitted is accurate.

  1. Apply Vaccine(s) by Brand:

Collection of Personal Information
Form Security
  1. Protected by FormShieldThe image on the left includes a random sequence of 6 numbers. We use this to block spam systems from abusing this form. Simply enter the 6 digits in the box below before submitting the form.
Page Last Modified: Monday, 08 September 2014.