Child Care Immunization Form Requirements

Required proof of immunization for admission to child care facilities
This page has been automatically translated from English. MSDH has not reviewed this translation and is not responsible for any inaccuracies.

The MSDH 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 Regional Health Officer, a physician, nurse, or designee.
  • Certificate of Medical Exemption (Form 122). This form must be signed by the State Epidemiologist or Deputy State Epidemiologist.
    More about medical exemptions from vaccinations
Last reviewed on Dec 3, 2019 request edits
Mississippi State Department of Health 570 East Woodrow Wilson Dr Jackson, MS 39216 866‑HLTHY4U Contact and information

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