Child Registering from Abroad Aged 6 and under

Child Registering from Abroad Aged 6 and under

As your child is registering from abroad it is very important that we obtain a full list of the childhood immunisations they have been given since birth.

Please complete this form so that we can add these details to their medical record.

We will check this against the UK immunisation schedule, and will contact you if any further immunisations are required.

Child's Details

Child's Surname *

Child's First Name *

Child's Date of Birth *

Immunisation Record 1

Name of Immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 2

Name of immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 3

Name of immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 4

Name of immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 5

Name of immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 6

Name of immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 7

Name of immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 8

Name of immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 9

Name of immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 10

Name of immunisation

Date immunisation was given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 11

Name of immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 12

Name of immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 13

Name of immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 14

Name of immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 15

Name of immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 16

Name of immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Immunisation Record 17

Name of immunisation

Date immunisation given

Was this the 1st, 2nd, 3rd dose or a booster?

Which country was this immunisation given in?

Additional Immunisations

If your child has had any additional immunisations you need to tell us about. Please give details below.

Please include the name, date, dose and country of each additional immunisation.

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Page last reviewed: 24 February 2025
Page created: 24 April 2023