Please note, it has been detected that you have scripting disabled in your browser, this may cause some limitations to apply, and some functions may not be available at all

* Denotes that the field is mandatory.

Use this form if you require details of immunisations provided by Council.

First name *

Last name *

Date of birth *

Name of primary school *

Which years were you at this primary school? *

Name of high school *

Which years were you at this high school? *

What kinds of records do you require? (e.g high school records, childhood records, something else) *

Given name(s) *

Surname *

Postal address *

Email address *

Phone number *

Please send me through the records via *