Certificate of Immunisation Request

Immunisation Form

Complete this form to request a Certificate of Immunisation either for yourself, or your child. Please note we only hold records given through the Kingborough Council run programs in the Kingborough municipality.

  • Details of the person immunised

  • DD slash MM slash YYYY

  • List of Schools and the Clinic

    List of locations where immunisations may have been administered. Please check at least one location. Please note: If the school or clinic that you attended is not in the list, then we do not hold the immunisation record. Please contact the relevant Council of the school or clinic you attended directly.
  • Please select one option.

  • Contact Details

    Enter the address you would like the Certificate of Immunisation sent to - leave the email address blank if you would like a hard copy posted.

  • Privacy Statement

    On application, client details will only be released to the client directly, or if the client is under 18 years of age, to the client's lawful guardian/s. In cases where the application is made by a person other than the client, documentation may be requested to confirm the applicant's relationship to the client.

  • Privacy Statement

    Council is collecting this information from you for the primary purpose of communicating with you regarding Council Business. The information will only be used and disclosed as prescribed under the Personal Information Act 2004. The Council requires this information to allow its officers to carry out Council Business. If you do not provide the information requested, Council will not be able to process this form. You may make an application to access or amend the information held by Council by contacting the relevant Council Officer on 6211 8200.

  • Our aim is to provide you with your immunisation records as quickly as possible. You should receive your Certificate of Immunisation within two days of your request.