Online Vaccination Reporting

Parents are Responsible for Providing up-to-date Vaccination Information

Submit this form each time your child receives a vaccination. All information collected by this secure form is confidential and will not be shared. Public Health maintains the immunization records for children in all schools and licensed child care centres within the Niagara region.

These records are used to protect your child if an outbreak of a vaccine-preventable disease occurs.

Keep your Yellow Immunization Card Current

It's important to keep your child's immunization record (yellow card) up to date. Keep your yellow card in a safe place with other valuable documents such as birth certificates, health cards and passports.

If you have any question or concerns, contact the Vaccine Preventable Disease Program at 905-688-8248 or 1-888-505-6074, ext. 7425.

Enter Your Child's Vaccination Data Here

Individual Information (* = Required Field)
First Name:*
 
Last Name:*
 
Gender:*
Date of Birth:*
Ont Health Card No:
School/Childcare Facility:
Parent/Guardian Name:
Parent/Guardian Phone:
Doctor's Name:
Vaccination Information

Specific vaccination details can be entered below. A complete vaccination record should include the following:

  • Vaccination Date
  • One or more vaccination checkboxes must be checked or the Other field must be completed
 
Vaccination Date
Diphtheria
Tetanus
Pertussis
Polio (IPV)
Polio (OPV)
HIB
Pneumo Conjugate
Rotavirus
Measles
Mumps
Rubella
Men-Conjugate-C
Men-Conjugate ACWY
Varicella
Hepatitis B
Human Papillomavirus
Seasonal Influenza
Pneumo Poly
Other
 

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