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PDF Tennessee Certificate of Immunization Form
(Signature/Stamp)
Address
1c. Check if needed
Dental Screening
City
State
Zip Code
Vision Screening
DATE
DATE
DATE
DATE
MM / DD / YY
MM / DD / YY
MM / DD / YY
MM / DD / YY
Medical
Exemption (X)
DATE
MM / DD / YY
History (YY)
DATE
MM / DD / YY
+Serology (YY)
VACCINE
Diagnosed (YY)
S
A
** M
V P
O L
ID E
**
Unless specifically exempted by law, Tennessee law requires a certificate on file for each child in attendance in any school or child care facility in Tennessee....
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FAQs printable immunization exemption form tennessee
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