Stawell Immunisation Bookings

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  • Please enter a contact phone number (we would prefer a mobile number).
  • Please enter your email address. We will use this to send you confirmation of your booking and additional information about your immunisation.
  • Please enter the full name and age of each child to be immunised. Click on the + at the end of the line to add additional children. Only one booking is required.
    Given name(s)SurnameDate of birthAge 
  • Please ensure you select a time you will be able to make.

    March 2023

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    DD slash MM slash YYYY
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  • Personal information requested on this form will only be used by council to carry out its functions and activities and will not be disclosed without your consent except where authorised by law.

    If you do not provide all or part of the personal information required we may not be able to process your request in an effective and efficient manner. You have the right to seek access to and correction of your personal information.

    I acknowledge that:
  • This field is for validation purposes and should be left unchanged.