Guerin Prep - Immunization form

Alumni Immunization Record Request Form

Please note that Holy Cross alumni records are kept by the Archdiocese of Chicago. Please call the archives office at 312-831-0711 x 722.

Mother Guerin and Guerin Prep alumni:

1) Complete and print the Alumni Immunization Record Request Form (below).

2) A $2 fee is required for each request. (Requests will not be processed without the appropriate fee.)

3) Immunization records are available since 1989.

4) Mail requests to:

Registrar's Office

Guerin College Preparatory High School

8001 West Belmont Avenue

River Grove, Illinois 60171

Alumni Immunization Record Request Form

Name

Maiden Name (if applicable)

Last Name

Graduation Year

School

Date of Birth

Address

City, State, Zip Code

Phone

I grant permission to release my immunization record to the following:

College/Employer/Self or Special instructions

Attention (name)

Street address:

City, State, Zip Code

Signature