Certificate of Immunization Record Submission

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Student's Last Name *
Student's Date of Birth *
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Immunization Record Upload *

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Please submit your child’s State of Louisiana Universal Certificate of Immunization record.
Immunization records must be current and signed by your child’s doctor.
Note: MyChart screenshots are not considered an official record of immunization.
NOTICE PURSUANT TO LA. R.S. § 17:170(E)(2)
In accordance with Act No. 675 (HB 47 of the Louisiana Legislature’s 2024 Regular Session)
and La. R.S. § 17:170(E)(2), please be advised of the following:
La. R.S. § 17:170(E)(1) provides that “No person attending or seeking to enter any school or facility enumerated in Subsection A of this Section shall be required to comply with the provisions of this Section, including any additional immunization or proof of immunity requirement adopted pursuant to the provisions of this Section, if the person is a distance learner or if the person or his parent or guardian submits either a written statement from a physician stating that the procedure is contraindicated for medical reasons, or a written dissent from the student or his parent or guardian.”