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THE VACCINATION ACT
(Section 6)
FORM 1
Certificate of Vaccination or Revaccination against Smallpox
This is to certify that .................................. date of birth .............................. sex ................. whose signature follows ........................................ has on the date indicated been vaccinated or re-vaccinated against smallpox.
Date	Signature and professional status of vaccinator	Approved Stamp		State whether primary vaccination or revaccination; if primary, whether successful
1.		1.	2.
2.
3.		3.	4.
4.
The validity of this certificate extends for a period of 3 years, beginning 8 days after the date of a successful vaccination, or, in the event of a revaccination, on the date of that revaccination.
The approved stamp mentioned above must be in a form prescribed by the Chief Medical Officer.
Any amendment of this certificate, or erasure, or failure to complete any part of it, may render it invalid.

The Vaccination Act

(Section 7)

FORM 2

Saint Lucia

I, the undersigned, hereby certify that I am of opinion that .............................. the child of ............................. of .......................... in the ................ District, aged is not now in a fit and proper state to be successfully vaccinated. I do hereby postpone the vaccination until the day of .......................................... 20.................

Dated this ......................................... day of .........................., 20...............

............................................................................

Medical Officer (or Public Vaccinator)

^*This must not exceed 2 months from the date of the Certificate.

The Vaccination Act

(Section 8)

FORM 3

Saint Lucia

I, the undersigned, hereby certify that I have ................................................. times unsuccessfully vaccinated ........................ the child of ....................... of ................... in the ....................................... District, aged ................................................(or that the child has already had smallpox, as the case may be) and I am of opinion that such child is unsusceptible of successful vaccination.

Dated this ..................................... day of ..............................., 20................

..........................................................................

Medical Officer (or Public Vaccinator)

The Vaccination Act

(Section 11)

FORM 4

Saint Lucia

I, the undersigned, hereby give you notice to have the child (insert name), whose birth is now registered, vaccinated within 3 months from the date of its birth, under the provisions and directions of the Vaccination Act and that in default of your so doing, the parent or persons having charge of the child will be liable to the penalties by the said Act imposed.

If you intend to apply to the medical officer of your district, I have to inform you that he or she will attend at ................................. on the ...................................................... day of ................................20..............., at ..................................... m.

Dated this .................................. day of ..........................., 20.....................

.........................................................................

Registrar of Civil Status District