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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.

Required by the State of Utah before your child's first day of care. The file is stored privately — only Sara can access it.

Please read in full

Where to get your record or exemption

Immunization record: ask your pediatrician for a printed copy, or request one yourself from the Utah Statewide Immunization Information System at https://immunize.utah.gov/usiis.

Exemption: complete the State of Utah online education module and bring or upload the signed exemption form — instructions at https://immunize.utah.gov/wp-content/uploads/Exemption_Module_Instructions_Website_Oct_2025.pdf.

Child

Child's full name *Date of birth *

Submission type

Type IMMUNIZED, EXEMPTION, or PENDING *IMMUNIZED if you're submitting an up-to-date record. EXEMPTION if submitting an official Utah exemption. PENDING if you're still gathering the document.If exemption — medical, religious, or personal

Details

Notes (vaccine list, dates, or anything Sara should know)

Upload

Upload immunization record or exemption (PDF, JPG, PNG)Optional but recommended. Max 10 MB. The file is private — only Sara can access it.

Parent / guardian

Parent / guardian name *Email address *

Signature

Type your full legal name as your signature *Date signed *

By submitting, I acknowledge:

I attest that the information and document I am submitting is accurate and up-to-date.
I understand the file is stored privately and only used to meet State of Utah childcare licensing requirements.

Your information is sent securely to Sara. We never share it.