CVSD Registration:  Certificate of Immunization Status (CIS)
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Email *
Student Last Name *
Student First Name *
Student Middle Name *
Student Date of Birth *
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I give permission to my child’s school/child care to add immunization information into the Immunization Information System to help the school maintain my child’s record.
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Conditional Status Only: I acknowledge that my child is entering school/child care in conditional status. For my child to remain in school, I must provide required documentation of immunization by established deadlines.
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Parent/Guardian Signature (please type first & last name)
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Date *
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