Immunization Record Form
Collect vaccination dates or an exemption, plus an upload of the official record for your file.
A ready-to-use daycare forms form for small teams who need a reliable intake process: 11 questions, 2 pages, 2 conditional rules.
- Questions
- 11
- Pages
- 2
- Layouts
- classic
- Conditional rules
- 2
- Typical time
- 5 min
Searches this template answers
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Live preview and test console
This is the real form. Answer it to test the 2 conditional rules — nothing is sent or stored.
Page 1 of 2 — Child
Every question on this page is currently visible.
What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.
Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.
Who this template is for
Immunization Record Form is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.
- Small teams who need a reliable intake process working in daycare forms.
- Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
- Anyone replacing chasing missing details over email with one structured record per enquiry.
- Respondents are the people you send it to — the form asks them 11 questions across 2 screens.
Why this form is useful
It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.
- 7 questions are required, so submissions arrive complete instead of needing a follow-up email.
- It accepts a document or photo upload as evidence.
- It records a signature you can keep as proof of agreement.
- It pins the request to a specific date.
- Conditional logic hides 2 questions until they are relevant — shorter forms convert better than long ones.
- Splitting the form across 2 pages keeps each screen short and shows respondents how much is left.
- Every response is stored, searchable and exportable, so nothing depends on one person's inbox.
How to use this template
From copy to live form is a few minutes of work, and every step is reversible.
- 1Press “Use this template” — a fresh copy of Immunization Record Form lands in your workspace, ready to edit.
- 2Rename or delete any question, and change what is required. Nothing here is fixed.
- 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
- 4Check the upload limits on the file question so respondents can attach what you actually need.
- 5Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
- 6Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.
Logic and conditions blueprint
Exactly how this form behaves as it is answered — 2 conditional rules ship with it.
- Features advanced show logic: if “Is your child up to date with the routine schedule?” is No, the form dynamically exposes “Tell us which are outstanding and when they're booked”. Otherwise that question never appears.
- Features advanced show logic: if “Are you claiming an exemption?” is Yes, the form dynamically exposes “Upload supporting documentation”. Otherwise that question never appears.
- All 2 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.
About this template
Chasing immunisation paperwork by email is a job nobody wants. This form asks for the dates you are required to hold, takes a photo of the official record as an attachment, and gives families a clear route to declare an exemption so your register shows a status for every child rather than a gap.
What this form asks
Every question is editable — rename it, make it optional, or delete it entirely.
Page 1 — Child
- Child's full namerequired
- Date of birthrequired
- Clinic or provider that holds the record
Page 2 — Status
- Is your child up to date with the routine schedule?required
- Tell us which are outstanding and when they're booked
- Upload the official immunisation recordrequired
- Date of most recent vaccination
- Are you claiming an exemption?required
- Upload supporting documentation
- Confirmationrequired
- Parent or guardian signaturerequired
11 questions in total.
How the form changes as it's filled in
This template ships with 2 conditional rules, grouped into 2 behaviours driven by 2 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.
Driven by “Is your child up to date with the routine schedule?”
- Reveals questions
If “Is your child up to date with the routine schedule?” is No, the form reveals “Tell us which are outstanding and when they're booked”.
Driven by “Are you claiming an exemption?”
- Reveals questions
If “Are you claiming an exemption?” is Yes, the form reveals “Upload supporting documentation”.
What it pairs with
Most teams don't run this form on its own. These are the forms and systems it sits next to.
Works in this layout
Forms that overlap this one
These pages cover the same subject ground as the immunization record form, matched on the words people actually search for.
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Privacy & compliance
This form asks about a child. Collect a guardian's consent, keep contact and medical answers to the minimum you actually need, and restrict who on your team can open the responses.
Frequently asked questions
Is the Immunization Record Form template free to use?
Yes. You can preview and test Immunization Record Form on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.
What does the Immunization Record Form template ask for?
It asks 11 questions across 2 pages, 7 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.
Can I edit the Immunization Record Form form after copying it?
Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic layout, restyle it to match your brand, and set who gets notified on each submission.
How does the conditional logic in this daycare forms form work?
2 conditional rules ship with the template: Features advanced show logic: if “Is your child up to date with the routine schedule?” is No, the form dynamically exposes “Tell us which are outstanding and when they're booked”. Otherwise that question never appears. Features advanced show logic: if “Are you claiming an exemption?” is Yes, the form dynamically exposes “Upload supporting documentation”. Otherwise that question never appears. All 2 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other. All rules are editable in the Logic tab.
Where do responses to the Immunization Record Form form go?
Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.
Can I embed the Immunization Record Form form on my own website?
Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.
Can respondents upload files?
Yes. This template includes a file upload question, so respondents can attach documents or photos with their answers. You can adjust the accepted file types and size limits on that question.
Is the signature on this form legally usable?
The template captures a drawn signature and stores it with the submission, along with the timestamp, so you keep evidence of who agreed and when. Whether that is sufficient depends on your jurisdiction and the agreement itself.
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