Wilson, NY · Niagara County
Medical History and Immunization Record 2025
This form collects health information for children in the Town of Wilson Summer Recreation Program and is completed by a parent or guardian.
What this form is
The Medical History and Immunization Record collects a child’s physician details, illnesses, injuries, allergies, health conditions, medications, and activity restrictions for the Town of Wilson Summer Recreation Program. A parent or guardian must complete and sign it for each participating child and attach a current 2025 immunization record from the child’s enrolled school or doctor. The form also includes permissions related to self-medication and approved sunscreen.
Who needs it
A parent or guardian of each child participating in the Town of Wilson Summer Recreation Program must complete and sign this form.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; attach the child’s current 2025 immunization record, and the parent or guardian signs and dates the form.
How to submit this form
- 1
Download The Form
Download the Medical History and Immunization Record 2025.
- 2
Complete The Form
A parent or guardian fills in the child’s health information and signs and dates the form.
- 3
Gather The Immunization Record
Attach a copy of the child’s current 2025 immunization record from the enrolled school or doctor.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the Medical History and Immunization Record?
- No. This document is signed without a notary. Attach the child’s current 2025 immunization record from the enrolled school or doctor, then sign and date the form.
- Who completes the Medical History and Immunization Record?
- A parent or guardian must complete and sign the form for each child participating in the Town of Wilson Summer Recreation Program.
- What information does the form ask for?
- It asks for physician information and details about the child’s illnesses, injuries, allergies, health conditions, medications, and activity restrictions. It also includes permissions related to self-medication and approved sunscreen.
- How do I submit the Medical History and Immunization Record?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Medical History and Immunization Record 2025 doesn’t need a notary — but if you have another Wilson form that does, a commissioned online notary can help.