Fillable
Admission Agreement
The State of Utah's official enrollment form — child information, parent information, emergency contacts, sign-out authorization, and permissions for emergency medical care and transportation.
Paperwork made simple
Forms & Immunizations
Fill out our required forms right here on the website. We'll email a copy to you and to Sara — no printing, no scanning. You can also download a blank PDF if you'd rather fill it out by hand.
Utah High Quality Certified
Every required form
Fill out online
Every form below has its own page where you can see the document and fill it out right there. Submit, and you and Sara both get an emailed copy.
Fillable
Health Assessment
A short health summary the State of Utah requires — allergies and food sensitivities, chronic conditions, current medications, and any special daily care instructions.
Fillable
Childcare Contract
The agreement between you and Country Lane Early Learning covering tuition, the 14-day probationary period, four-week termination notice, daily sign-in/out, and how policy changes are handled. E-sign online — a signed copy is emailed to you and to Sara.
Fillable
Medication Permission
Required by the State of Utah for any medication — prescription or over-the-counter — left with the provider. One form per medication. Sara cannot give your child any medication without a current, signed permission form on file.
Fillable
Immunization Record or Exemption
Submit your child's Utah immunization record or official exemption form. You can type the details below, upload the official document (PDF or photo), or do both. Sara receives a secure link to the file.
Fillable
Client Rights Acknowledgement
The official Utah Department of Health & Human Services Client Rights notice for licensed childcare. This is posted in our home — please review it below and sign to confirm you've read it.
How to get one
Immunizations or exemption
Required by the State of Utah before your child's first day of care. Submit the record or exemption directly through the Immunization Record form — type the details and/or upload the official document.
Option A
Get your child's immunization record
- Ask your child's pediatrician for a printed immunization record (most clinics will email or print one same-day).
- Or request one yourself from the Utah Statewide Immunization Information System (USIIS). Visit immunize.utah.gov/usiis to request a copy.
- Submit the record through our Immunization Record form before your child's first day.
Option B
Request a Utah exemption
- Visit immunize.utah.gov/vaccination-exemption-form for the official Utah exemption process.
- Complete the online education module (medical, religious, or personal exemption).
- Upload the signed exemption form through our Immunization Record form before your child's first day.
Need help with any of it?
Reach out anytime and we'll walk you through it.