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Certificate of Immunisation Request
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
Name
*
First
Last
Please enter any other name you have been known by, if applicable.
First
Last
Date of Birth
*
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.
Select at least one of the following locations:
*
Blackmans Bay Primary School
Bruny Island District School
Calvin Christian High School
Calvin Christian Primary School
Channel Christian School
Illawarra Primary School
Kingston High School
Kingston Primary School
Margate Primary School
Snug Primary School
Southern Christian College
St Aloysius Catholic College - Huntingfield Campus
St Aloysius Catholic College - Kingston Campus
Taroona High School
Taroona Primary School
Woodbridge School
Kingborough Council Clinic
I am requesting the release of the immunisation records for the below:
*
Please select one option.
Myself
My Child
If this is for your child's records, please enter your name here
First
Last
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.
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Email
Phone
*
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.
Declaration
*
I declare that the information I have provided is, to the best of my knowledge, true and correct.
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.
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