name: Other immunizations, test results or Vaccine comments B B Dates given (D/M/Y) BCG Polio Mumps Measles Rubella Varicella Pertussis Rotavirus Diphtheria Hepatitis Meningococcal Pneumococcal (Chickenpox) Haemophilus Tetanus (HIB) Physician’s Signature: Physician’s Address: Telephone No. ( ) Date : Call the Toronto Public Health Immunization Infoline at 416-392-1250 to ask any questions about immunization.
name: Vaccine Dates given (D/M/Y) Diphtheria Tetanus Pertussis Polio Haemophilus B (HIB) Pneumococcal Rotavirus Measles Mumps Rubella Meningococcal Varicella (Chickenpox) Hepatitis B BCG Other immunizations, test results or comments Physician’s Signature: Physician’s Address: Telephone No. ( ) Date : Call the Toronto Public Health Immunization Infoline at 416-392-1250 to ask any questions about immunization.
Oriole_Registration_Package_2016_2017.docx