Online Vaccination Reporting for Children 0 - 17 Years

Do not report any COVID-19 vaccination details through the online vaccination portal. Keep the client record given to you after vaccination with your immunization records and let your health care professional know you were immunized.

Parents / legal guardians and children 16 years of age and older are responsible for reporting vaccines directly to Public Health. Health care providers and schools do not do this for you. Vaccines received at a school clinic run by Niagara Region Public Health don't need to be reported here. Report vaccines received from Public Health to your health care provider.

Submit this form each time your child receives a vaccination (except for COVID-19 vaccinations and flu shots).

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 in Niagara.

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

Keep your yellow immunization card up to date

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

* = Required

Child Information

Gender

* Date of birth

By providing your health care provider's name, you are authorizing Niagara Region Public Health to communicate with that health care provider about immunization issues.

Parent / Guardian Information

Vaccination Record Type

What type of vaccination record are you reporting?

Outside Ontario Vaccination Information

Submit photo(s) of your vaccination record sheets below:

  • Only .jpg and .png files will be accepted
  • Up to 5 MB each, no more than 10 MB total

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
Date
Vaccine brand name (if known)
Diphtheria
Tetanus
Pertussis
Polio
Hib
Pneumococcal
Rotavirus
Measles
Mumps
Rubella
Varicella
Men-C (at 1 year)
Men-Conjugate-ACYW (in grade 7)
Hepatitis B
HPV (Human Papillomavirus)
Hepatitis A
Men B
Other diseases

Personal Information and Privacy

Any personal information or personal health information submitted in writing will be collected, used and disclosed by members of Regional Council and Regional staff in accordance with the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act, where applicable.

Freedom of Information

Any information you share will be used only for the intended purpose for which it was provided. If you have any questions, email foi@niagararegion.ca or call 905-980-6000 ext. 3779.

Page Feedback Did you find what you were looking for today?