CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 2.32.032, s. 10D-3.088, F.A.C. and s. 10M-12, F.A.C. LAST NAME PARENT OR GUARDIAN FIAIST MI DOB MO/DA/YR Child's SS# (optional) STATE IMMUNIZATION ION Directions: • Enter all appropriate doses and dates below. • Sign and date ap