These requirements can be waived only if a properly signed health, religious, or personal conviction waiver is filed with the child care center.
Step 4: if the child meets all requirements, sign at step 5 and return this form to the child care center.
Records: if you do not have an immunization record for this child, contact your doctor or local public health department to obtain the records.
New age level: children who reach a new age/grade level while attending this child care must have their records updated with dates of additional required doses.
| Question | Answer |
|---|---|
| Form Name | Form F-44192 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 6 min |
| Edition | 03/2025 |
| Matches the agency's file | Yes, checked October 4, 2026 |
| Other names | F-44192, F44192, Form F-44192, Child Care Immunization Record |
| State | Wisconsin |
| Issuing Agency | Wisconsin Dept. of Health Services |
| Filing Deadline | 30 days from enrollment |
| Official source | Form F-44192 (Rev 03/2025), Wisconsin Department of Health Services |
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