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Immunization

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You are Here: Home Page > Child Care Programs, Schools and Post-Secondary Institutions > Immunization School Survey Worksheets

Immunization School Survey Worksheets

Child Care Programs and Pre-K

  • Immunization Worksheet for Pre-k/Day Care for Children Less Than 1 Year of Age (7/2021) (PDF)
  • Immunization Worksheet for Pre-k/Day Care for Children 1 Year of Age and Older (7/2021) (PDF)
  • Pre-k Day Care School Immunization Survey Medical Exemption Worksheet (10/2020) (PDF)

Pre-K Through Grade 12

  • Immunization Worksheet for Pre-k/Day Care for Children Less Than 1 Year of Age (7/2021) (PDF)
  • Immunization Worksheet for Pre-k/Day Care for Children 1 Year of Age and Older (7/2021) (PDF)
  • Immunization Worksheet for Kindergarten to Grade 5 (7/2021) (PDF)
  • Immunization Worksheet for Grade 6 (7/2021) (PDF)
  • Immunization Worksheet for Grade 7 (7/2021) (PDF)
  • Immunization Worksheet for Grades 8-11 (7/2021) (PDF)
  • Immunization Worksheet for Grade 12 (7/2021) (PDF)
  • Pre-k Day Care School Immunization Survey Medical Exemption Worksheet (10/2020) (PDF)
  • Kindergarten Through 5 School Immunization Survey Medical Exmption Worksheet (12/2020) (PDF)
  • Grades 6 Through 12 School Immunization Survey Medical Exmption Worksheet (12/2020) (PDF)
Questions or comments: immunize@health.ny.gov
Revised: July 2021

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